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General NPI Number Information
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NPI Number | 1952575508
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Entity Type | Organization
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Legal Business Name | CENTINELA RECOVERY GROUP, INC.
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 422 WARREN LN
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City | INGLEWOOD
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State | CA
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Zip | 90302-3116
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Country | US
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Telephone | 310-962-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 367 LA COLINA DR.
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City | INGLEWOOD
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State | CA
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Zip | 90302-3117
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Country | US
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Telephone | 310-962-0548
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Fax | 310-696-9903
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Authorized Official
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Title or Position | EXECTIVE DIRECTOR
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Name | MR. SHEIKH ABDUL AL-AMIN
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Credential |
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Telephone | 310-962-0548
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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 | 190580AN
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License Number State | CA
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