| NPI | 1760180699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZEENA FOTEH Administrator 310-686-9689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2024-06-13 |