MEDICARE: WEST HOLLYWOOD ATC

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

General Provider Information

NPI Number	:	1417415639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST HOLLYWOOD ATC

Provider Business Mailing Address
First Line	:	9024 HARRATT ST
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-3804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9026 HARRATT ST
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-3804
Country	:	US
Telephone Number	:	855-740-1181
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRANDAN FREEMAN
Credential	:
Telephone Number	:	855-740-1181

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	12/30/2020

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Directions to “WEST HOLLYWOOD ATC ” Practice Location

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