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General NPI Number Information
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NPI Number | 1215387667
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Entity Type | Organization
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Legal Business Name | ANGEL WINGS RECOVERY OF SOUTH BAY
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 3841 W 130TH ST
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City | HAWTHORNE
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State | CA
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Zip | 90250-5311
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Country | US
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Telephone | 310-863-7446
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Fax |
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Provider Business Mailing Address
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Address Line | 3841 W 130TH ST
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City | HAWTHORNE
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State | CA
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Zip | 90250-5311
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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 | CEO
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Name | PHIL COOKES
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Credential |
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Telephone | 310-863-7446
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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 | 190849BN
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License Number State | CA
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