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General NPI Number Information
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NPI Number | 1386463099
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Entity Type | Organization
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Legal Business Name | HILLSIDES
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 456 E ORANGE GROVE BLVD STE 140
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City | PASADENA
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State | CA
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Zip | 91104-5235
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Country | US
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Telephone | 626-765-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 940 AVENUE 64
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City | PASADENA
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State | CA
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Zip | 91105-2711
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Country | US
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Telephone | 323-254-2274
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Fax |
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Authorized Official
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Title or Position | QA MANAGER ADMINISTRATION
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Name | MARISOL LARA
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Credential |
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Telephone | 323-254-2274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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