Healthcare Provider Details

I. General information

NPI: 1154728244
Provider Name (Legal Business Name): 700 S. SILVER RIDGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W COMPTON BLVD
COMPTON CA
90220-3008
US

IV. Provider business mailing address

439 W COMPTON BLVD
COMPTON CA
90220-3008
US

V. Phone/Fax

Practice location:
  • Phone: 323-243-2949
  • Fax:
Mailing address:
  • Phone: 323-243-2949
  • 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

VIII. Authorized Official

Name: MR. PHILIP BOWLAY-WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 818-259-5312