MEDICARE: LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE

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	:	1134832322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE

Provider Business Mailing Address
First Line	:	3675 HUNTINGTON DR # 101
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-5645
Country	:	US
Telephone Number	:	626-314-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	3675 HUNTINGTON DR # 101
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-5645
Country	:	US
Telephone Number	:	626-314-2818
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JUAN M NAVARRO
Credential	:
Telephone Number	:	562-777-7500

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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