MEDICARE: AMERICAN DRUG RECOVERY PROGRAM 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	251S00000X	Community/Behavioral Health Agency	190530AP	CA

General Provider Information

NPI Number	:	1669719068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DRUG RECOVERY PROGRAM INC.

Provider Business Mailing Address
First Line	:	2724 W FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-5143
Country	:	US
Telephone Number	:	323-759-3464
Fax Number	:	323-759-3427

Provider Business Practice Location Address
First Line	:	2714 W FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-5151
Country	:	US
Telephone Number	:	323-759-3464
Fax Number	:	323-759-3427

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EHIGIMETOR INEGBENOISE
Credential	:
Telephone Number	:	323-759-3464

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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