Healthcare Provider Details

I. General information

NPI: 1689858672
Provider Name (Legal Business Name): DIXON RECOVERY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 CRENSHAW BLVD 2ND FLOOR
LOS ANGELES CA
90043-1233
US

IV. Provider business mailing address

4715 CRENSHAW BLVD
LOS ANGELES CA
90043-1233
US

V. Phone/Fax

Practice location:
  • Phone: 323-988-3744
  • Fax:
Mailing address:
  • Phone: 323-292-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RONDA DIXON
Title or Position: EXECUTIVE DIRECTOR
Credential: JD
Phone: 323-244-5677