MEDICARE: CAST CENTERS LLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1114388840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAST CENTERS LLC

Provider Business Mailing Address
First Line	:	630 N DOHENY DR
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-5506
Country	:	US
Telephone Number	:	310-873-3935
Fax Number	:	310-564-1883

Provider Business Practice Location Address
First Line	:	630 N DOHENY DR
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-5506
Country	:	US
Telephone Number	:	310-873-3935
Fax Number	:	310-564-1883

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STEPHANIE L. GRAYSON
Credential	:	PH.D.
Telephone Number	:	310-873-3935

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	03/08/2016

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Directions to “CAST CENTERS LLC ” Practice Location

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