Healthcare Provider Details

I. General information

NPI: 1225448640
Provider Name (Legal Business Name): LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S SAN PEDRO ST
LOS ANGELES CA
90013-2119
US

IV. Provider business mailing address

470 E. 3RD ST. SUITE A & B
LOS ANGELES CA
90013
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6411
  • Fax: 213-626-8115
Mailing address:
  • Phone: 213-626-6411
  • Fax: 213-626-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190100EN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERICA CAMPOS
Title or Position: SUBSTANCE ABUSE COUNSELOR
Credential: R.W
Phone: 213-626-6411