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General NPI Number Information
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NPI Number | 1962657643
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Entity Type | Organization
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Legal Business Name | CENTURY REGIONAL DETENTION FACILITY
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 6610 RIVERTON AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2209
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Country | US
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Telephone | 818-255-8254
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Fax |
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Provider Business Mailing Address
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Address Line | 6610 RIVERTON AVE
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91606-2209
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Country | US
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Telephone | 818-255-8254
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGY INTERN
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Name | MS. MARY DAVID
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Credential | MA
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Telephone | 818-255-8254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 390200000X
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License Number State | CA
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