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General NPI Number Information
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NPI Number | 1013467091
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Entity Type | Organization
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Legal Business Name | FORTITUDE RECOVERY LLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 2477 FLETCHER DR
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City | LOS ANGELES
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State | CA
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Zip | 90039-2801
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Country | US
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Telephone | 323-375-5959
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Fax | 323-419-3165
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Provider Business Mailing Address
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Address Line | 2477 FLETCHER DR
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City | LOS ANGELES
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State | CA
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Zip | 90039-2801
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Country | US
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Telephone | 323-375-5959
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Fax | 323-419-3165
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ROD AMIRI
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Credential | M.D.
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Telephone | 323-375-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 0002934671-0001-4
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License Number State | CA
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