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General NPI Number Information
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NPI Number | 1942407960
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Entity Type | Organization
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Legal Business Name | LOS ANGELES DRUG TREATMENT CENTER
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3211 WEST IMPERIAL HWY SAME AS MAILING ADDRESS
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City | INGLEWOOD
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State | CA
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Zip | 90303
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Country | US
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Telephone | 310-419-9616
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Fax | 310-419-9617
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Provider Business Mailing Address
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Address Line | 3211 WEST IMPERIAL HWY
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City | INGLEWOOD
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State | CA
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Zip | 90303
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Country | US
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Telephone | 310-419-9616
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Fax | 310-419-9617
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SAMUEL A ADELEYE
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Credential | D,O,
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Telephone | 310-419-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 190561AP
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License Number State | CA
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