Organization
HEALTH VIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHEAL FITZGERALD (DIRECTOR)
(310) 984-3055
Entity
Organization
Contact information
Practice address
5880 FAIR ISLE DR APT 166, RIVERSIDE, CA 92507-8458
(310) 869-1252
Mailing address
921 S BEACON ST, SAN PEDRO, CA 90731-3740
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390200000X
STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM
CA
Enumeration date
10/01/2010
Last updated
10/01/2010
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