Organization · NPI-2

Blueberry Way

Community Based Residential Treatment Facility, Mental Illness · Los Angeles, CA

NPI number1770437618
StatusActive
Last updated in NPPESMar 30, 2026

Details

NPI
1770437618
Entity type
Organization (NPI-2)
Legal business name
Blueberry Way
Organization subpart
No
Enumeration date
Feb 26, 2026
Certification date
Mar 30, 2026
Last updated
Mar 30, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320800000X Community Based Residential Treatment Facility, Mental Illness––Yes
261QM0850X Clinic/Center, Adult Mental Health––
324500000X Substance Abuse Rehabilitation Facility––
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder––

Practice location

1653 S Rimpau Blvd
Los Angeles, CA 90019-5658

Phone 818-613-3277

Mailing address

11853 S. Inglewood Blvd.
Hawthorne, CA 90250

Other practice locations

1651 S Rimpau Blvd
Los Angeles, CA 90019-5658

Phone 818-613-3277

4802 St. Charles Place
Los Angeles, CA 90019

Phone 818-613-3277

Authorized official

Vitali Alkabetz
Ceo
8186133277

Is something wrong?

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