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General NPI Number Information
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NPI Number | 1073439980
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Entity Type | Organization
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Legal Business Name | LOS ANGELES DETOX AND TREATMENT CENTER
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 702 W 49TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90037-3324
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Country | US
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Telephone | 213-332-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 2316 JEANS CT
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City | SIGNAL HILL
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State | CA
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Zip | 90755-4046
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Country | US
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Telephone | 213-332-2428
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Fax | 800-843-0066
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. MESHAWN DAVIS
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Credential |
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Telephone | 310-933-4459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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