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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DEBORAH GIBSON (EXECUTIVE ADMINISTRATION)
(310) 337-7417
Entity
Organization

Contact information

Practice address
8939 S SEPULVEDA BLVD, SUITE 460, LOS ANGELES, CA 90045-3631
(310) 337-7417
Mailing address
8939 S SEPULVEDA BLVD, SUITE 460, LOS ANGELES, CA 90045-3631

Taxonomy

Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary

Other

Enumeration date
04/14/2008
Last updated
04/14/2008
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