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General NPI Number Information
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NPI Number | 1629526504
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Entity Type | Organization
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Legal Business Name | THE HOUSE OF BETHESDA
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 14614 FIRMONA AVE
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City | LAWNDALE
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State | CA
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Zip | 90260-1339
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Country | US
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Telephone | 310-675-1444
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Fax | 310-675-1333
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Provider Business Mailing Address
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Address Line | 14614 FIRMONA AVE
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City | LAWNDALE
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State | CA
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Zip | 90260-1339
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Country | US
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Telephone | 310-675-1444
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Fax | 310-675-1333
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROBERT EARL SMITH
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Credential |
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Telephone | 310-675-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 191601689
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License Number State | CA
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