| NPI | 1124160080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK HICKMAN C.E.O. 818-956-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: CA 19-139) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-02-06 |