Organization
LOS ANGELES DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH RONALD FOWLER (CEO)
(562) 912-0291
Entity
Organization
Contact information
Practice address
522 N LARCHMONT BLVD, LOS ANGELES, CA 90004-1306
(562) 912-0291
Mailing address
516 N LARCHMONT BLVD, LOS ANGELES, CA 90004-1306
(562) 912-0291
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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