Healthcare Provider Details

I. General information

NPI: 1629201629
Provider Name (Legal Business Name): REHOBOTH COURAGE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 W COMPTON BLVD
COMPTON CA
90220-3015
US

IV. Provider business mailing address

716 W COMPTON BLVD
COMPTON CA
90220-3015
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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