Healthcare Provider Details

I. General information

NPI: 1912853474
Provider Name (Legal Business Name): CBWX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E 113TH ST
LOS ANGELES CA
90059-1611
US

IV. Provider business mailing address

905 E 113TH ST
LOS ANGELES CA
90059-1611
US

V. Phone/Fax

Practice location:
  • Phone: 213-605-6501
  • Fax:
Mailing address:
  • Phone: 213-605-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: RONDA DIXON
Title or Position: CEO
Credential: JD
Phone: 323-641-2731