Healthcare Provider Details

I. General information

NPI: 1073439980
Provider Name (Legal Business Name): LOS ANGELES DETOX AND TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W 49TH ST
LOS ANGELES CA
90037-3324
US

IV. Provider business mailing address

2316 JEANS CT
SIGNAL HILL CA
90755-4046
US

V. Phone/Fax

Practice location:
  • Phone: 213-332-2428
  • Fax:
Mailing address:
  • Phone: 213-332-2428
  • Fax: 800-843-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MESHAWN DAVIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 310-933-4459