MEDICARE: DEVELOPMENT SPECIALTY PROJECTS, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	190413UP	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7228	OTHER	CA	DMC PROVIDER NUMBER

General Provider Information

NPI Number	:	1619186152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENT SPECIALTY PROJECTS, INC.

Provider Business Mailing Address
First Line	:	19300 RINALDI STREET
Second Line	:	SUITE 8720
City	:	NORTHRIDGE
State	:	CA
Zip	:	91327-9998
Country	:	US
Telephone Number	:	909-821-8023
Fax Number	:	818-804-4047

Provider Business Practice Location Address
First Line	:	6801 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-1840
Country	:	US
Telephone Number	:	909-821-8023
Fax Number	:	818-804-4047

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID MCGUIRE
Credential	:
Telephone Number	:	909-821-8023

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/18/2008

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