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	171M00000X	Case Manager/Care Coordinator
2	324500000X	Substance Abuse Rehabilitation Facility	190100BN	CA

General Provider Information

NPI Number	:	1457641250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE

Provider Business Mailing Address
First Line	:	12070 TELEGRAPH RD STE 207
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-8213
Country	:	US
Telephone Number	:	562-777-7500
Fax Number	:	562-777-7510

Provider Business Practice Location Address
First Line	:	1084 NEW YORK DR
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-3118
Country	:	US
Telephone Number	:	562-777-7500
Fax Number	:	562-777-7510

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT
Name	:	MRS. CONNIE REYNOSA
Credential	:	LCSW
Telephone Number	:	562-777-7500

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	01/26/2026

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