Basic Information
| Provider Information | |||||||||
| NPI: | 1356960512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12070 TELEGRAPH RD STE 207 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906708213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627777500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8919 CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH GATE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902803013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235641800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2020 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | REYNOSA | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5627777500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE | ||||||||
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| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.