MEDICARE: THE DISCOVERY PROGRAM

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	3245S0500X	Children's Substance Abuse Rehabilitation Facility	190330AP	CA
2	3245S0500X	Children's Substance Abuse Rehabilitation Facility	190330BP	CA

General Provider Information

NPI Number	:	1821200551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DISCOVERY PROGRAM

Provider Business Mailing Address
First Line	:	10573 W PICO BLVD
Second Line	:	PMB # 82
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2333
Country	:	US
Telephone Number	:	310-843-0246
Fax Number	:	310-843-0245

Provider Business Practice Location Address
First Line	:	1831 BENECIA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5011
Country	:	US
Telephone Number	:	310-843-0246
Fax Number	:	310-843-0245

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS MAKIDA JONES
Credential	:
Telephone Number	:	310-843-0246

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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Directions to “THE DISCOVERY PROGRAM ” Practice Location

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