Basic Information
| Provider Information | |||||||||
| NPI: | 1750816062 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4626 N GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917242055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263315316 | ||||||||
| FaxNumber: | 6263322219 | ||||||||
| Practice Location | |||||||||
| Address1: | 4626 NORTH GRAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | AOVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917242055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263315316 | ||||||||
| FaxNumber: | 6263322219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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| AuthorizedOfficialLastName: | RUEDI | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6263315316 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.