Healthcare Provider Details

I. General information

NPI: 1639553670
Provider Name (Legal Business Name): LOS ANGELES CENTER FOR ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 E 3RD ST SUITE A AND B
LOS ANGELES CA
90013-1629
US

IV. Provider business mailing address

470 E 3RD ST SUITE A AND B
LOS ANGELES CA
90013-1629
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: BILL TARKANIAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 562-906-2676