Healthcare Provider Details

I. General information

NPI: 1396926754
Provider Name (Legal Business Name): BEIT T'SHUVAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 VENICE BLVD
LOS ANGELES CA
90034-3223
US

IV. Provider business mailing address

8831 VENICE BLVD
LOS ANGELES CA
90034-3223
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-5200
  • Fax: 310-838-3545
Mailing address:
  • Phone: 310-204-5200
  • Fax: 310-838-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190326AN
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190326AN
License Number StateCA

VIII. Authorized Official

Name: SERGIO RIZZO-FONTANESI
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 310-204-5200