Basic Information
Provider Information | |||||||||
NPI: | 1811135866 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | I-ADARP, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CRI-HELP OUTPATIENT | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11027 BURBANK BLVD | ||||||||
Address2: |   | ||||||||
City: | NORTH HOLLYWOOD | ||||||||
State: | CA | ||||||||
PostalCode: | 916012431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8189858323 | ||||||||
FaxNumber: | 8189854297 | ||||||||
Practice Location | |||||||||
Address1: | 8330 LANKERSHIM BLVD. | ||||||||
Address2: |   | ||||||||
City: | NORTH HOLLYWOOD | ||||||||
State: | CA | ||||||||
PostalCode: | 91605 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8189947454 | ||||||||
FaxNumber: | 8182521410 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/29/2009 | ||||||||
LastUpdateDate: | 07/22/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BERNSTEIN | ||||||||
AuthorizedOfficialFirstName: | JACOB | ||||||||
AuthorizedOfficialMiddleName: | SHELDON | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
AuthorizedOfficialTelephone: | 8189858323 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/22/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 190321AN | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.