Organization
WINGS OF REFUGE
Active
Organization
WINGS OF REFUGE
Active
Other names
Wings of Recovery - Los Angeles High School
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE G MONCITO (PRESIDENT & CEO)
(310) 670-6767
Entity
Organization
Contact information
Practice address
4650 W OLYMPIC BLVD, LOS ANGELES, CA 90019-1831
(323) 900-2700
(323) 936-8455
Mailing address
5777 W CENTURY BLVD, SUITE 910, LOS ANGELES, CA 90045-5600
(310) 670-6767
(310) 670-2626
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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