Healthcare Provider Details

I. General information

NPI: 1659599843
Provider Name (Legal Business Name): AMERICAN DRUG TREATMENT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 S FIGUEROA ST
LOS ANGELES CA
90003-1024
US

IV. Provider business mailing address

6200 S FIGUEROA ST P O BOX 82117
LOS ANGELES CA
90003-1024
US

V. Phone/Fax

Practice location:
  • Phone: 323-753-3939
  • Fax: 323-753-9889
Mailing address:
  • Phone: 323-753-3939
  • Fax: 323-753-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT INEGBENEDION
Title or Position: CEO
Credential:
Phone: 323-753-3939