Healthcare Provider Details

I. General information

NPI: 1124457858
Provider Name (Legal Business Name): BREATHE WEHO TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 MELROSE AVE FL 3
LOS ANGELES CA
90046-7039
US

IV. Provider business mailing address

8060 MELROSE AVE FL 3
LOS ANGELES CA
90046-7039
US

V. Phone/Fax

Practice location:
  • Phone: 800-929-5904
  • Fax: 855-275-5428
Mailing address:
  • Phone: 800-929-5904
  • Fax: 855-275-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190788AP
License Number StateCA

VIII. Authorized Official

Name: JEAN ANN DOCKERY
Title or Position: DIRECTOR OF REVENUE CYCLE MANAGEMEN
Credential:
Phone: 800-929-5904