Healthcare Provider Details

I. General information

NPI: 1134474760
Provider Name (Legal Business Name): LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ORR AND DAY RD
SANTA FE SPRINGS CA
90670-4161
US

IV. Provider business mailing address

11015 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4601
US

V. Phone/Fax

Practice location:
  • Phone: 562-906-2676
  • Fax:
Mailing address:
  • Phone: 562-906-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190100BN
License Number StateCA

VIII. Authorized Official

Name: BRENDA WEIEWEL
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 562-906-2676