Organization
MC INTYRE HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MILTON T MARISTELA R.N. (EXECUTIVE DIRECTOR)
(323) 662-0855
Entity
Organization
Contact information
Practice address
544 N KENMORE AVE, LOS ANGELES, CA 90004-6815
(323) 662-0855
(323) 662-0842
Mailing address
544 N KENMORE AVE, LOS ANGELES, CA 90004-6815
(323) 662-0855
(323) 662-0842
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
190420AN
CA
Other
Enumeration date
11/02/2011
Last updated
11/02/2011
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