Healthcare Provider Details

I. General information

NPI: 1689586968
Provider Name (Legal Business Name): ABOVE AND BEYOND CARE PROVIDERS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 CRENSHAW BLVD
LOS ANGELES CA
90005-3622
US

IV. Provider business mailing address

670 CRENSHAW BLVD # 101
LOS ANGELES CA
90005-3622
US

V. Phone/Fax

Practice location:
  • Phone: 909-210-0365
  • Fax: 562-202-5009
Mailing address:
  • Phone: 323-695-1799
  • Fax: 562-202-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRIA MARAVILLA DUFRENNE
Title or Position: CEO
Credential: RN
Phone: 909-210-0365