MEDICARE: CALIFORNIA HEALTH, ALCOHOL &. DRUG EDUCATION 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	2737106	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197015000	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1790903904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA HEALTH, ALCOHOL &. DRUG EDUCATION PROGRAM, INC.

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR. STE. 423
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3614
Country	:	US
Telephone Number	:	323-294-7662
Fax Number	:	323-294-7703

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR. STE. 423
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3614
Country	:	US
Telephone Number	:	323-294-7662
Fax Number	:	323-294-7703

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GEORGE C. NZE
Credential	:
Telephone Number	:	951-833-8426

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	11/30/2012

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