| NPI | 1104383694 |
|---|---|
| Doing Business As | 310 RESIDENTIAL |
| Entity Type | Organization |
| Authorized Contact | DANIEL MEDINA Director 310-710-1652 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2019-02-21 |