Healthcare Provider Details

I. General information

NPI: 1265761811
Provider Name (Legal Business Name): REHOBOTH DRUG AND ALCOHOL PREVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 W COMPTON BLVD
COMPTON CA
90220
US

IV. Provider business mailing address

568 W COMPTON BLVD
COMPTON CA
90220-3011
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-0789
  • Fax: 310-627-9130
Mailing address:
  • Phone: 310-663-0789
  • Fax: 310-627-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number19DG
License Number StateCA

VIII. Authorized Official

Name: MR. ADEFEMI OLUFISAYO ADEGBESAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MED
Phone: 310-663-0789