MEDICARE: LOS ANGELES COUNTY OUTPATIENT 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1982991055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS ANGELES COUNTY OUTPATIENT PROGRAM

Provider Business Mailing Address
First Line	:	2680 SATURN AVE STE 180
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4568
Country	:	US
Telephone Number	:	323-397-9796
Fax Number	:

Provider Business Practice Location Address
First Line	:	2680 SATURN AVE. 180
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255
Country	:	US
Telephone Number	:	323-397-9796
Fax Number	:

Authorized Official
Title or Position	:	DRUG COUNSELOR
Name	:	MARK COLE
Credential	:	CERTIFY COUNSELOR
Telephone Number	:	323-397-9796

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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