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NPI Code Detail

MEDICARE: LINCOLN HEIGHTS TREATMENT CENTER, LLC

MEDICARE: LINCOLN HEIGHTS TREATMENT CENTER, LLC
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1275219123
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINCOLN HEIGHTS TREATMENT CENTER, LLC
Provider Business Mailing Address
First Line : 3619 N MISSION RD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-3136
Country : US
Telephone Number : 213-494-2487
Fax Number :
Provider Business Practice Location Address
First Line : 2029 KEITH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-3128
Country : US
Telephone Number : 213-494-2487
Fax Number :
Authorized Official
Title or Position : COMPLIANCE
Name : ANGELA N MCMAHON
Credential : EDD
Telephone Number : 619-871-7345
Provider Enumeration Date : 06/26/2023
Last Update Date : 06/26/2023

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