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General NPI Number Information
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NPI Number | 1922451574
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Entity Type | Organization
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Legal Business Name | CHABAD OF CALIFORNIA
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 1750 S LA CIENEGA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-4602
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Country | US
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Telephone | 323-965-1365
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 S LA CIENEGA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-4602
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Country | US
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Telephone | 323-965-1365
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID KOVI BLAUNER
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Credential |
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Telephone | 323-965-1365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 190087DN
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License Number State | CA
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