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 |