Healthcare Provider Details

I. General information

NPI: 1134493497
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 N MISSION RD
LOS ANGELES CA
90032-2554
US

IV. Provider business mailing address

4099 N MISSION RD
LOS ANGELES CA
90032-2554
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-1746
  • Fax: 323-221-7156
Mailing address:
  • Phone: 323-221-1746
  • Fax: 323-221-7156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. FELIPE RODRIGUEZ
Title or Position: SUPERVISOR
Credential: CLINICAL SUPERVISOR
Phone: 323-221-1746