=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689031585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED RECOVERY NETWORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2016
-----------------------------------------------------
Last Update Date | 01/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 WILSHIRE BLVD. SUITE 650
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-1996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-977-9447
-----------------------------------------------------
Fax | 213-402-2807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 WILSHIRE BLVD. SUITE 650
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90017-1996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-977-9447
-----------------------------------------------------
Fax | 213-402-2807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. MARSHA TEMPLE
-----------------------------------------------------
Credential | J.D.
-----------------------------------------------------
Telephone | 213-977-9447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------