Basic Information
| Provider Information | |||||||||
| NPI: | 1427050244 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | L.A. CADA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11015 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906704601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629062686 | ||||||||
| FaxNumber: | 5629062687 | ||||||||
| Practice Location | |||||||||
| Address1: | 11015 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906704601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629062686 | ||||||||
| FaxNumber: | 5629062687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NAVARRO | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ACTING EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5629062686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 190100 | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.