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General NPI Number Information
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NPI Number | 1790974798
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Entity Type | Organization
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Legal Business Name | CRISTIAN CENTER MANOR ALCOHOL AND DRUG BEHAVIOR CENTER
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 8721 S BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90003-3321
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Country | US
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Telephone | 323-752-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 8721 S BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90003-3321
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Country | US
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Telephone | 323-752-3700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILL THOMAS WASHINGTON
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Credential |
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Telephone | 323-751-3896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 109445AN
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License Number State | CA
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