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Organization
SOCAL INNOVATIVE BEHAVIORAL HEALTH LLC
Active
Organization
SOCAL INNOVATIVE BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK GRANDPRE (OWNER)
(310) 927-3060
Entity
Organization
Contact information
Practice address
104 S ROOSEVELT AVE, PASADENA, CA 91107-4126
(310) 927-3060
Mailing address
104 S ROOSEVELT AVE, PASADENA, CA 91107-4126
(310) 927-3060
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/27/2021
Last updated
10/27/2021
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