Healthcare Provider Details

I. General information

NPI: 1922668441
Provider Name (Legal Business Name): CORE MELROSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 MELROSE AVE
LOS ANGELES CA
90069-5404
US

IV. Provider business mailing address

8302 MELROSE AVE
LOS ANGELES CA
90069-5404
US

V. Phone/Fax

Practice location:
  • Phone: 323-351-1790
  • Fax:
Mailing address:
  • Phone: 323-351-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSH ALOMIA
Title or Position: COO
Credential:
Phone: 718-931-9700