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General NPI Number Information
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NPI Number | 1972719185
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Entity Type | Organization
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Legal Business Name | CROWN CITY ADHC, INC.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 122 N EL MOLINO AVE
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City | PASADENA
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State | CA
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Zip | 91101-1805
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Country | US
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Telephone | 626-583-8822
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Fax | 626-583-8844
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Provider Business Mailing Address
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Address Line | 122 N EL MOLINO AVE
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City | PASADENA
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State | CA
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Zip | 91101-1805
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Country | US
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Telephone | 626-583-8822
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Fax | 626-583-8844
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ALEX LEO STEINE
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Credential | MBA
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Telephone | 626-583-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | CA
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