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NPI Code Detail

MEDICARE: AURORA CHARTER OAK-LOS ANGELES, LLC

MEDICARE: AURORA CHARTER OAK-LOS ANGELES, 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
1283Q00000XPsychiatric Hospital

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619934114
Entity Type Code : Organization
Provider Name (Legal Business Name) : AURORA CHARTER OAK-LOS ANGELES, LLC
Provider Business Mailing Address
First Line : 1161 E COVINA BLVD
Second Line :
City : COVINA
State : CA
Zip : 91724-1523
Country : US
Telephone Number : 626-966-1632
Fax Number : 626-859-5292
Provider Business Practice Location Address
First Line : 1161 E COVINA BLVD
Second Line :
City : COVINA
State : CA
Zip : 91724-1523
Country : US
Telephone Number : 626-966-1632
Fax Number : 626-859-5292
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. TODD SMITH
Credential :
Telephone Number : 626-966-1632
Provider Enumeration Date : 04/27/2006
Last Update Date : 08/22/2020

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Directions to “AURORA CHARTER OAK-LOS ANGELES, LLC ” Practice Location

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