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General NPI Number Information
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NPI Number | 1376324467
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA HEALTH & REHABILITATION PROGRAM
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 8750 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-4830
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Country | US
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Telephone | 310-631-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 INDUSTRY WAY STE A
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City | LYNWOOD
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State | CA
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Zip | 90262-4028
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Country | US
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Telephone | 310-631-8004
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Fax | 323-905-1938
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | DR. JACK MICHAEL BARBOUR
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Credential | MD
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Telephone | 310-631-8004
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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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