Healthcare Provider Details

I. General information

NPI: 1659748473
Provider Name (Legal Business Name): AXIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 CHEVIOT VISTA PL
LOS ANGELES CA
90034-3509
US

IV. Provider business mailing address

3215 CHEVIOT VISTA PL
LOS ANGELES CA
90034-3509
US

V. Phone/Fax

Practice location:
  • Phone: 310-202-1593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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. SAMUEL DEKIN
Title or Position: COO
Credential:
Phone: 760-641-3972