Healthcare Provider Details

I. General information

NPI: 1447541248
Provider Name (Legal Business Name): 180 CENTER LA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 SUMMITRIDGE DR
BEVERLY HILLS CA
90210-1607
US

IV. Provider business mailing address

1775 SUMMITRIDGE DR
BEVERLY HILLS CA
90210-1607
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-4180
  • Fax:
Mailing address:
  • Phone: 888-588-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190704AP
License Number StateCA

VIII. Authorized Official

Name: ALEX SHERBET
Title or Position: CEO
Credential:
Phone: 323-899-9115