Renewal
Clinic/Center, Rehabilitation, Substance Use Disorder in Los Angeles, CA. Organization (NPI-2).
NPI number1174072003
StatusActive
Last updated in NPPESOct 4, 2016
Details
- NPI
- 1174072003
- Entity type
- Organization (NPI-2)
- Legal business name
- Renewal
- Organization subpart
- No
- Enumeration date
- Oct 4, 2016
- Last updated
- Oct 4, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | Yes |
Practice location
672 S La Fayette Park PlLos Angeles, CA 91607
Phone 917-374-4215
Mailing address
4931 Bluebell AveLos Angeles, CA 91607
Authorized official
Elliot Liebhard
Administrator
9173744215
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