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General NPI Number Information
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NPI Number | 1083136188
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Entity Type | Organization
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Legal Business Name | BLVD CENTERS, INC.
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 518 QUEENSLAND CIR
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City | CORONA
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State | CA
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Zip | 92879-1381
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Country | US
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Telephone | 424-372-1123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 512030
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City | LOS ANGELES
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State | CA
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Zip | 90051-0030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. JASON MONROE
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Credential |
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Telephone | 602-550-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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