Organization
STUDIO 12
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN W. FISKE (CEO)
(818) 761-7374
Entity
Organization
Contact information
Practice address
12406 MAGNOLIA BLVD, VALLEY VILLAGE, CA 91607-2415
(818) 761-7374
(818) 761-7377
Mailing address
12406 MAGNOLIA BLVD, VALLEY VILLAGE, CA 91607-2415
(818) 761-7374
(818) 761-7377
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
190361AN
CA
Other
Enumeration date
06/04/2007
Last updated
08/22/2020
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