Organization · Type 2 NPI
Renewal
Substance Use Disorder Rehabilitation Clinic/Center · Los Angeles, CA
NPI number
1174072003
Active
Practice location
672 S La Fayette Park Pl
Los Angeles, CA 91607
Mailing address
4931 Bluebell Ave
Los Angeles, CA 91607
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center Primary | 261QR0405X | None listed |
Substance Use Disorder Rehabilitation Clinic/Center: Definition to come...
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About NPI 1174072003
Renewal's National Provider Identifier is 1174072003, issued on Oct 4, 2016. The primary taxonomy on file is Substance Use Disorder Rehabilitation Clinic/Center (261QR0405X), and the practice location is in Los Angeles, CA. The record was last updated on Oct 4, 2016.