Healthcare Provider Details

I. General information

NPI: 1992489595
Provider Name (Legal Business Name): LOS ANGELES BEHAVIOR HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21540 PLUMMER ST STE A
CHATSWORTH CA
91311-4143
US

IV. Provider business mailing address

17609 VENTURA BLVD STE 215
ENCINO CA
91316-5126
US

V. Phone/Fax

Practice location:
  • Phone: 661-305-0265
  • Fax: 818-867-8360
Mailing address:
  • Phone: 818-571-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MELINDA DRAKE
Title or Position: ADMINISTRATOR
Credential: LCSW
Phone: 661-305-0265