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General NPI Number Information
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NPI Number | 1902340474
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Entity Type | Organization
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Legal Business Name | OPEN HEART RECOVERY
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Dates
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Enumeration Date | 12/18/2016
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Last Update Date | 12/18/2016
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Provider Practice Location Address
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Address Line | 4026 6TH AVE
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City | LOS ANGELES
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State | CA
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Zip | 90008-2733
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Country | US
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Telephone | 323-389-8894
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Fax |
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Provider Business Mailing Address
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Address Line | 4026 6TH AVE
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City | LOS ANGELES
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State | CA
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Zip | 90008-2733
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Country | US
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Telephone | 323-389-8894
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. RODERICK L BROWN
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Credential |
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Telephone | 310-307-9299
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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 | 190947AP
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License Number State | CA
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