Healthcare Provider Details

I. General information

NPI: 1821200551
Provider Name (Legal Business Name): THE DISCOVERY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 BENECIA AVE
LOS ANGELES CA
90025-5011
US

IV. Provider business mailing address

10573 W PICO BLVD PMB # 82
LOS ANGELES CA
90064-2333
US

V. Phone/Fax

Practice location:
  • Phone: 310-843-0246
  • Fax: 310-843-0245
Mailing address:
  • Phone: 310-843-0246
  • Fax: 310-843-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number190330AP
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number190330BP
License Number StateCA

VIII. Authorized Official

Name: MISS MAKIDA JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-843-0246