Healthcare Provider Details

I. General information

NPI: 1356960512
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: 04/08/2020
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8919 CALIFORNIA AVE
SOUTH GATE CA
90280-3013
US

IV. Provider business mailing address

12070 TELEGRAPH RD STE 207
SANTA FE SPRINGS CA
90670-8213
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-1800
  • Fax:
Mailing address:
  • Phone: 562-777-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CONNIE REYNOSA
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 562-777-7500