28th Street Detox LLC
Substance Abuse Rehabilitation Facility in San Diego, CA. Organization (NPI-2).
NPI number1134826688
StatusActive
Last updated in NPPESFeb 21, 2023
Details
- NPI
- 1134826688
- Entity type
- Organization (NPI-2)
- Legal business name
- 28th Street Detox LLC
- Organization subpart
- No
- Enumeration date
- Feb 14, 2023
- Certification date
- Feb 21, 2023
- Last updated
- Feb 21, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | – | – | Yes |
Practice location
1119 28th StSan Diego, CA 92102-2203
Phone 754-368-1285
Mailing address
120 N Federal Hwy Ste 101Lake Worth, FL 33460-3493
Phone 754-368-1285
Authorized official
Sehar Ryan
Coo
7543681285
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