Healthcare Provider Details

I. General information

NPI: 1235340241
Provider Name (Legal Business Name): CIRCLE OF FRIENDS OUTPATIENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2429 PACIFIC AVE
LONG BEACH CA
90806-2901
US

IV. Provider business mailing address

2429 PACIFIC AVE
LONG BEACH CA
90806-2901
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-7150
  • Fax: 323-465-3214
Mailing address:
  • Phone: 562-595-7150
  • Fax: 323-465-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. STEVEN PROSHAK
Title or Position: CEO
Credential:
Phone: 323-465-5888