Basic Information
| Provider Information | |||||||||
| NPI: | 1811435308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SENETHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2646 SOUTH LA SALLE AVENUE # 8 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235295568 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4445 BURNS AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900292702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236648940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2017 | ||||||||
| LastUpdateDate: | 02/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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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.