Healthcare Provider Details

I. General information

NPI: 1184859548
Provider Name (Legal Business Name): DIXON RECOVERY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E 111TH ST RMS. 241 & 327
LOS ANGELES CA
90061-3003
US

IV. Provider business mailing address

4715 CRENSHAW BLVD #14
LOS ANGELES CA
90043-1233
US

V. Phone/Fax

Practice location:
  • Phone: 323-244-5677
  • Fax: 323-988-9672
Mailing address:
  • Phone: 323-244-5677
  • Fax: 323-988-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190622AN
License Number StateCA

VIII. Authorized Official

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