MEDICARE: CALIFORNIA FAMILIY INSTITUTE MELROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	538463	CA

General Provider Information

NPI Number	:	1093113383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA FAMILIY INSTITUTE MELROSE

Provider Business Mailing Address
First Line	:	6708 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-3412
Country	:	US
Telephone Number	:	818-601-5878
Fax Number	:

Provider Business Practice Location Address
First Line	:	6708 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-3412
Country	:	US
Telephone Number	:	818-601-5878
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIRSTEN WALLACE
Credential	:
Telephone Number	:	818-651-4594

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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