| NPI | 1861948705 |
|---|---|
| Doing Business As | COMMONWEALTH BEHAVIORAL |
| Entity Type | Organization |
| Authorized Contact | KIRSTEN AMANDA WALLACE Chief Executive Office 818-651-4594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 190809AN) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: 190808AN) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: 190809AN) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |