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General NPI Number Information
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NPI Number | 1265892079
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Entity Type | Organization
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Legal Business Name | DIXON RECOVERY INSTITUTE, INC.
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1512 W SLAUSON AVE RMS. 103, 202 & 210
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City | LOS ANGELES
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State | CA
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Zip | 90047-1230
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Country | US
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Telephone | 866-593-6660
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Fax | 866-593-6660
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Provider Business Mailing Address
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Address Line | 3860 AMBERLY DR UNIT D
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City | INGLEWOOD
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State | CA
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Zip | 90305-3431
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Country | US
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Telephone | 866-593-6660
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Fax | 866-593-6660
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. RONDA DIXON
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Credential |
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Telephone | 866-593-6660
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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 | 190622AN
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License Number State | CA
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