MEDICARE: CENTRE OF POSITIVE ESSENTIALS, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1447584065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRE OF POSITIVE ESSENTIALS, INC

Provider Business Mailing Address
First Line	:	8391 BEVERLY BLVD
Second Line	:	PMB 437
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2633
Country	:	US
Telephone Number	:	213-880-2440
Fax Number	:	323-299-0194

Provider Business Practice Location Address
First Line	:	8391 BEVERLY BLVD
Second Line	:	PMB 437
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-2633
Country	:	US
Telephone Number	:	213-880-2440
Fax Number	:	323-299-0194

Authorized Official
Title or Position	:	CEO/CFLO
Name	:	MS. JEANNE M STEEN
Credential	:
Telephone Number	:	213-880-2440

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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