| NPI | 1003505496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULO ANTHONY GRAYSON CEO 310-892-0535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2024-05-07 |