Healthcare Provider Details

I. General information

NPI: 1245360130
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W EL SEGUNDO BLVD
HAWTHORNE CA
90250-3317
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2816
  • Fax: 323-754-2828
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190007GN
License Number StateCA

VIII. Authorized Official

Name: MS. TERI CANNON
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 310-679-9126