Healthcare Provider Details

I. General information

NPI: 1700180155
Provider Name (Legal Business Name): DIXON RECOVERY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 CRENSHAW BLVD
LOS ANGELES CA
90043-1233
US

IV. Provider business mailing address

7054 VANSCOY AVE
NORTH HOLLYWOOD CA
91605-5357
US

V. Phone/Fax

Practice location:
  • Phone: 323-244-5677
  • Fax: 818-759-6072
Mailing address:
  • Phone: 323-244-5677
  • Fax: 818-759-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

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