Basic Information
| Provider Information | |||||||||
| NPI: | 1164814349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL CENTRO DE AMISTAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12817 BURBANK BLVD. | ||||||||
| Address2: | 6 | ||||||||
| City: | VALLEY VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187261271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7038 OWENSMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913033198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183478565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | NUNEZ | ||||||||
| AuthorizedOfficialFirstName: | MARISOL | ||||||||
| AuthorizedOfficialMiddleName: | EDITH | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH CLINICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8187261271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | IMF76860 | CA | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.