Basic Information
| Provider Information | |||||||||
| NPI: | 1194044974 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HELPING KIDS TO RECOVER, INC. | ||||||||
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| OtherOrganizationName: | ANIMO WATTS CHARTER HIGH SCHOOL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 637 E ALBERTONI ST | ||||||||
| Address2: | 200 | ||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907461539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102170616 | ||||||||
| FaxNumber: | 3102170545 | ||||||||
| Practice Location | |||||||||
| Address1: | 12628 AVALON BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102170616 | ||||||||
| FaxNumber: | 3102170545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2010 | ||||||||
| LastUpdateDate: | 05/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOYD | ||||||||
| AuthorizedOfficialFirstName: | CHYNETHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3102170616 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HELPING KIDS TO RECOVER, INC. | ||||||||
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| AuthorizedOfficialCredential: | M.B.A.,RAS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No ID Information.