Organization
CASA BLANCA OUTPATIENT SERVICES
Active
Other names
Universal Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
JASON VAUGHN SHOEMAKER PHD (CEO)
(310) 795-4066
Entity
Organization
Contact information
Practice address
3246 CAHUENGA BLVD W, LOS ANGELES, CA 90068-1302
(310) 795-4066
Mailing address
8033 W SUNSET BLVD # 946, WEST HOLLYWOOD, CA 90046-2401
(310) 622-9795
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/08/2018
Last updated
05/06/2020
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