Healthcare Provider Details

I. General information

NPI: 1477885382
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: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4601
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: 562-906-2681
Mailing address:
  • Phone: 562-906-2676
  • Fax: 562-906-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190100BN
License Number StateCA

VIII. Authorized Official

Name: MRS. BRENDA WIEWEL
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 562-906-2676