| NPI | 1972236172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAVACKUS DAWSON President 213-924-5275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QH0100X Clinic/Center Health Service | |
| 261QR0400X Clinic/Center Rehabilitation | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 261QR0800X Clinic/Center Recovery Care | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2022-07-05 |