Healthcare Provider Details

I. General information

NPI: 1396962031
Provider Name (Legal Business Name): ALCOHOLISM CENTER FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 S ALVARADO ST
LOS ANGELES CA
90006-4100
US

IV. Provider business mailing address

1147 S ALVARADO ST
LOS ANGELES CA
90006-4100
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-8500
  • Fax: 213-381-9410
Mailing address:
  • Phone: 213-381-8500
  • Fax: 213-381-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190002AN
License Number StateCA

VIII. Authorized Official

Name: MS. LORETTE HERMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-381-8515