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NPI Code Detail

MEDICARE: CHABAD RESIDENTIAL TREATMENT CENTER

MEDICARE: CHABAD RESIDENTIAL TREATMENT CENTER
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
1324500000XSubstance Abuse Rehabilitation Facility190087CNCA

General Provider Information

NPI Number : 1841429669
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHABAD RESIDENTIAL TREATMENT CENTER
Provider Business Mailing Address
First Line : 5675 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90036-4712
Country : US
Telephone Number : 323-965-1365
Fax Number : 323-965-0444
Provider Business Practice Location Address
First Line : 5675 W OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90036-4712
Country : US
Telephone Number : 323-965-1365
Fax Number : 323-965-0444
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MS. DONNA LYNN MILLER
Credential : MFT
Telephone Number : 323-965-1365
Provider Enumeration Date : 07/14/2009
Last Update Date : 03/31/2016

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Directions to “CHABAD RESIDENTIAL TREATMENT CENTER ” Practice Location

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