Healthcare Provider Details

I. General information

NPI: 1902147036
Provider Name (Legal Business Name): BASEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CARSON PLAZA DRIVE STE 106
CARSON CA
90746
US

IV. Provider business mailing address

460 E CARSON PLAZA DR STE 106
CARSON CA
90746-3228
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-6030
  • Fax: 310-532-8441
Mailing address:
  • Phone: 310-532-6030
  • Fax: 310-532-8441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. BASSEY ENUN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-532-6030