| NPI | 1205275195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK HICKMAN CEO 818-956-3737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: CA 19-124) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-02-25 |