Basic Information
| Provider Information | |||||||||
| NPI: | 1851471056 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN CALIFORNIA ALCOHOL AND DRUG PROGRAMS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AWAKENINGS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11500 PARAMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629234545 | ||||||||
| FaxNumber: | 5628620918 | ||||||||
| Practice Location | |||||||||
| Address1: | 12322 CLEARGLEN AVE | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906043872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629473835 | ||||||||
| FaxNumber: | 5629479895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | APPEL | ||||||||
| AuthorizedOfficialFirstName: | LYNNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5629234545 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X | 190011KN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No ID Information.