MEDICARE: CARRARA TREATMENT WELLNESS & SPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1093493652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRARA TREATMENT WELLNESS & SPA

Provider Business Mailing Address
First Line	:	1814 MARCHEETA PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-1116
Country	:	US
Telephone Number	:	424-421-6610
Fax Number	:	213-334-4100

Provider Business Practice Location Address
First Line	:	1814 MARCHEETA PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-1116
Country	:	US
Telephone Number	:	424-421-6610
Fax Number	:	213-334-4100

Authorized Official
Title or Position	:	CFO
Name	:	MR. DANIEL CHRISTIAN
Credential	:
Telephone Number	:	205-712-2153

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	06/03/2024

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