| NPI | 1003697137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GANELLO Administrator 323-872-8721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2024-12-16 |