MEDICARE: DIXON RECOVERY INSTITUTE, INC.

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	251S00000X	Community/Behavioral Health Agency	190622AN	CA

General Provider Information

NPI Number	:	1265892079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIXON RECOVERY INSTITUTE, INC.

Provider Business Mailing Address
First Line	:	3860 AMBERLY DR
Second Line	:	UNIT D
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-3431
Country	:	US
Telephone Number	:	866-593-6660
Fax Number	:	866-593-6660

Provider Business Practice Location Address
First Line	:	1512 W SLAUSON AVE
Second Line	:	RMS. 103, 202 & 210
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1230
Country	:	US
Telephone Number	:	866-593-6660
Fax Number	:	866-593-6660

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. RONDA DIXON
Credential	:
Telephone Number	:	866-593-6660

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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