1750876835 NPI number — BREATHE WEHO TREATMENT SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750876835 NPI number — BREATHE WEHO TREATMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREATHE WEHO TREATMENT SERVICES
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:
Provider Other Organization Name Type Code:
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:
1750876835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8060 MELROSE AVE FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90046-7039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-929-5904
Provider Business Mailing Address Fax Number:
855-275-5428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8020 JOVENITA CANYON DR
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:
90046-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-929-5904
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DOCKERY
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF RCM
Authorized Official Telephone Number:
800-929-5904

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  190788BP , 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)





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