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General NPI Number Information
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NPI Number | 1235698218
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Entity Type | Organization
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Legal Business Name | CRESCENT RECOVERY HOUSE
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/18/2019
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Provider Practice Location Address
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Address Line | 7339 W 91ST ST
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City | LOS ANGELES
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State | CA
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Zip | 90045-3428
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Country | US
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Telephone | 310-925-2781
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Fax |
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Provider Business Mailing Address
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Address Line | 369 S DOHENY DR # 278
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3508
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Country | US
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Telephone | 310-925-2781
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN HOLLOWAY
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Credential |
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Telephone | 310-925-2781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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