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Organization

NOVO DETOX

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MATTHEW ZIERING (CFO)
(310) 663-8890
Entity
Organization

Contact information

Practice address
11346 THURSTON PL, LOS ANGELES, CA 90049-2429
(602) 430-7543
Mailing address
10533 WASHINGTON BLVD, CULVER CITY, CA 90232-3311
(310) 663-8890

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
320800000X
Mental Illness Community Based Residential Treatment Facility
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
190982AP
STATE LICENSE
CA
Enumeration date
08/23/2017
Last updated
07/21/2022
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