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NPI Code Detail

MEDICARE: COVENANT HOUSE CALIFORNIA

MEDICARE: COVENANT HOUSE CALIFORNIA
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
1251B00000XCase Management Agency
2320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1518169325
Entity Type Code : Organization
Provider Name (Legal Business Name) : COVENANT HOUSE CALIFORNIA
Provider Business Mailing Address
First Line : 1325 N WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5615
Country : US
Telephone Number : 323-461-3131
Fax Number : 323-957-6491
Provider Business Practice Location Address
First Line : 1325 N WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5615
Country : US
Telephone Number : 323-461-3131
Fax Number : 323-957-7419
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. BILL BEDROSSIAN
Credential : MSW
Telephone Number : 323-461-3131
Provider Enumeration Date : 06/04/2007
Last Update Date : 01/30/2017

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Directions to “COVENANT HOUSE CALIFORNIA ” Practice Location

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