Healthcare Provider Details

I. General information

NPI: 1457641250
Provider Name (Legal Business Name): LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 NEW YORK DR
ALTADENA CA
91001-3118
US

IV. Provider business mailing address

12070 TELEGRAPH RD STE 207
SANTA FE SPRINGS CA
90670-8213
US

V. Phone/Fax

Practice location:
  • Phone: 562-777-7500
  • Fax: 562-777-7510
Mailing address:
  • Phone: 562-777-7500
  • Fax: 562-777-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190100BN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CONNIE REYNOSA
Title or Position: EXECUTIVE ASSISTANT
Credential: LCSW
Phone: 562-777-7500