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General NPI Number Information
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NPI Number | 1265761811
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Entity Type | Organization
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Legal Business Name | REHOBOTH DRUG AND ALCOHOL PREVENTION CENTER
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 568 W COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90220
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Country | US
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Telephone | 310-663-0789
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Fax | 310-627-9130
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Provider Business Mailing Address
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Address Line | 568 W COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90220-3011
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Country | US
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Telephone | 310-663-0789
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Fax | 310-627-9130
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ADEFEMI OLUFISAYO ADEGBESAN
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Credential | MED
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Telephone | 310-663-0789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation 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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 19DG
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License Number State | CA
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Taxonomy #3
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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 | CA
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