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General NPI Number Information
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NPI Number | 1760840094
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Entity Type | Organization
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Legal Business Name | CAMDEN RESIDENTIAL PROGRAM, LLC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 530 HILGARD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90024-3224
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Country | US
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Telephone | 310-424-0853
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Fax |
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Provider Business Mailing Address
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Address Line | 10780 SANTA MONICA BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90025-7613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JESSICA KLEIN
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Credential |
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Telephone | 424-320-4853
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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 | CA
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