MEDICARE: WILSHIRE TREATMENT CENTER, 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	261QM2800X	Methadone Clinic	19133	CA

General Provider Information

NPI Number	:	1497885081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSHIRE TREATMENT CENTER, INC

Provider Business Mailing Address
First Line	:	11901 SANTA MONICA BLVD STE 204
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2783
Country	:	US
Telephone Number	:	310-268-2446
Fax Number	:	310-479-0861

Provider Business Practice Location Address
First Line	:	11901 SANTA MONICA BLVD STE 204
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2783
Country	:	US
Telephone Number	:	310-268-2446
Fax Number	:	310-479-0861

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. KAT KARIMI
Credential	:	MBA
Telephone Number	:	310-268-2446

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	02/27/2013

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