1053732255 NPI number — CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE

Table of content: (NPI 1053732255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053732255 NPI number — CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AGUILA RECOVERY HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053732255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3316-3322 W. BEVERLY BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEBELLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-722-4529
Provider Business Mailing Address Fax Number:
323-722-4450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 N AVENUE 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90042-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-258-2921
Provider Business Practice Location Address Fax Number:
323-254-4131
Provider Enumeration Date:
12/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DUPLESSIS
Authorized Official First Name:
GERMEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PROJECT DIRECTOR
Authorized Official Telephone Number:
323-722-4529

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  197804181 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 197804181 . This is a "DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com