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General NPI Number Information
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NPI Number | 1932940889
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Entity Type | Organization
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Legal Business Name | COAST RECOVERY TREATMENT CENTER LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 4789 VINELAND AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3518
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Country | US
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Telephone | 213-347-4022
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Fax |
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Provider Business Mailing Address
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Address Line | 5748 WILLOWCREST AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-2122
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Country | US
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Telephone | 213-347-4022
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERENCE C FROST
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Credential | MPHIL, BPHIL NCDMA
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Telephone | 213-347-4022
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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 |
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License Number State |
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