Socal Innovative Behavioral Health LLC
Community/Behavioral Health in Pasadena, CA. Organization (NPI-2).
NPI number1760146583
StatusActive
Last updated in NPPESOct 27, 2021
Details
- NPI
- 1760146583
- Entity type
- Organization (NPI-2)
- Legal business name
- Socal Innovative Behavioral Health LLC
- Organization subpart
- No
- Enumeration date
- Oct 27, 2021
- Certification date
- Oct 27, 2021
- Last updated
- Oct 27, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
104 S Roosevelt AvePasadena, CA 91107-4126
Phone 310-927-3060
Mailing address
104 S Roosevelt AvePasadena, CA 91107-4126
Phone 310-927-3060
Authorized official
Mark Grandpre
Owner
3109273060
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