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General NPI Number Information
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NPI Number | 1467051672
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Entity Type | Organization
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Legal Business Name | SPEARHEAD HEALTH CENTERS, LLC.
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 11704 WILSHIRE BLVD STE 226
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City | LOS ANGELES
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State | CA
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Zip | 90025-1504
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Country | US
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Telephone | 310-494-7356
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Fax |
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Provider Business Mailing Address
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Address Line | 15516 W SUNSET BLVD APT 202
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-3542
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Country | US
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Telephone | 919-903-4941
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RYAN GARTRELL
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Credential | CADC
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Telephone | 919-903-4941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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