Healthcare Provider Details

I. General information

NPI: 1184774507
Provider Name (Legal Business Name): KEDREN ACUTE PSYCHIATRIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 AVALON BLVD SUITE 2
LOS ANGELES CA
90011-5622
US

IV. Provider business mailing address

4211 AVALON BLVD SUITE 2
LOS ANGELES CA
90011-5622
US

V. Phone/Fax

Practice location:
  • Phone: 323-432-5183
  • Fax: 323-231-9414
Mailing address:
  • Phone: 323-432-5183
  • Fax: 323-231-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43260
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN H GRIFFITH
Title or Position: PRESIDENT & CEO
Credential: PHD
Phone: 323-233-0425