Healthcare Provider Details

I. General information

NPI: 1346223781
Provider Name (Legal Business Name): CHOICES OF LONG BEACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 10TH ST
LONG BEACH CA
90813-5035
US

IV. Provider business mailing address

PO BOX 40119
LONG BEACH CA
90804-6119
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-9010
  • Fax: 562-590-8045
Mailing address:
  • Phone: 562-590-9010
  • Fax: 562-590-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number198600681
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190487BP
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number198600681
License Number StateCA

VIII. Authorized Official

Name: MR. SEAN E ZULLO
Title or Position: DIRECTOR
Credential: NCRS CPRP CCDC COADC
Phone: 562-590-9010