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General NPI Number Information
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NPI Number | 1003139668
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Entity Type | Organization
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Legal Business Name | DEPAREMENT OF MANTAL HEALTH
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 1000 W CARSON ST
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City | TORRANCE
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State | CA
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Zip | 90502-2004
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Country | US
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Telephone | 310-222-1648
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Fax | 310-222-5651
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Provider Business Mailing Address
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Address Line | 1000 W CARSON ST
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City | TORRANCE
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State | CA
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Zip | 90502-2004
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Country | US
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Telephone | 310-222-1648
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Fax | 310-222-5651
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MS. VICKIE BURRIS
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Credential | LICENSE
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Telephone | 310-222-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 362151
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 362151
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License Number State | CA
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