Healthcare Provider Details

I. General information

NPI: 1770924680
Provider Name (Legal Business Name): BHS PACIFICA HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
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

2501 W. EL SEGUNDO BLVD.
HAWTHORNE CA
90250
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2816
  • Fax: 323-754-2828
Mailing address:
  • Phone: 323-754-2816
  • Fax: 323-754-2828

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. SAMUEL A MCINTOSH
Title or Position: COUNSELOR
Credential:
Phone: 323-754-2816