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General NPI Number Information
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NPI Number | 1467094722
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Entity Type | Organization
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Legal Business Name | ADDICTION RECOVERY CENTER LA LLC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 4734 SUNNYSLOPE AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2410
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Country | US
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Telephone | 310-993-0146
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Fax | 714-603-7416
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Provider Business Mailing Address
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Address Line | 4734 SUNNYSLOPE AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-2410
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Country | US
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Telephone | 310-993-0146
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Fax | 714-603-7415
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JULIE ANN CORTEZ
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Credential |
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Telephone | 310-993-0146
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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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