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General NPI Number Information
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NPI Number | 1639665516
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Entity Type | Organization
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Legal Business Name | TRAINING CENTER EPHESIANS 4:11-16
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 525 GRAND AVE
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City | SPRING VALLEY
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State | CA
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Zip | 91977-5933
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Country | US
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Telephone | 619-327-5400
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Fax | 619-324-5410
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Provider Business Mailing Address
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Address Line | 525 GRAND AVE
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City | SPRING VALLEY
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State | CA
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Zip | 91977-5933
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Country | US
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Telephone | 619-327-5400
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Fax | 619-324-5410
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Authorized Official
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Title or Position | CENTER MANAGER
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Name | MICHAEL ALAN LAZARUS
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Credential | CATC-II
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Telephone | 619-327-5400
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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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