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Organization
IMMACULATE CARE CENTER INC
Active
Organization
IMMACULATE CARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GODDAY E. IMAKAVAR (EXECUTIVE DIRECTOR)
(213) 383-1124
Entity
Organization
Contact information
Practice address
3540 WILSHIRE BLVD, SUITE 818, LOS ANGELES, CA 90010-2307
(213) 383-1124
(213) 383-0261
Mailing address
3540 WILSHIRE BLVD, SUITE 818, LOS ANGELES, CA 90010-2307
(213) 383-1124
(213) 383-0261
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
190479AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190479AN
ADP
CA
Enumeration date
02/26/2007
Last updated
08/22/2020
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