MEDICARE: LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE

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	251S00000X	Community/Behavioral Health Agency	190100BN	CA

General Provider Information

NPI Number	:	1700131240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE

Provider Business Mailing Address
First Line	:	11015 BLOOMFIELD AVE
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-4601
Country	:	US
Telephone Number	:	562-906-2676
Fax Number	:

Provider Business Practice Location Address
First Line	:	12417 PHILADELPHIA ST
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-3933
Country	:	US
Telephone Number	:	562-906-2676
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BRENDA WIEWEL
Credential	:	LCSW
Telephone Number	:	562-906-2676

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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