Healthcare Provider Details

I. General information

NPI: 1770437618
Provider Name (Legal Business Name): BLUEBERRY WAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 S RIMPAU BLVD
LOS ANGELES CA
90019-5658
US

IV. Provider business mailing address

11853 S. INGLEWOOD BLVD.
HAWTHORNE CA
90250
US

V. Phone/Fax

Practice location:
  • Phone: 818-613-3277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: VITALI ALKABETZ
Title or Position: CEO
Credential:
Phone: 818-613-3277