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General NPI Number Information
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NPI Number | 1528229879
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Entity Type | Organization
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Legal Business Name | REBUILD CALIFORNIA ALLIANCE
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 145 W 99TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90003-4114
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Country | US
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Telephone | 323-422-1124
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Fax | 323-531-4063
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Provider Business Mailing Address
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Address Line | 7622 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90003-2326
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Country | US
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Telephone | 323-422-1124
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Fax | 323-920-7380
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Authorized Official
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Title or Position | FOUNDER
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Name | DEANTWAN MARQUIS FITTS
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Credential |
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Telephone | 323-422-1124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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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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