Organization
SAINT LAWRENCE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAWRENCE KSIDO (CEO)
(747) 250-4884
Entity
Organization
Contact information
Practice address
12437 HUSTON ST, VALLEY VILLAGE, CA 91607-3517
(747) 250-4884
Mailing address
14617 ARMINTA ST, PANORAMA CITY, CA 91402-5901
(747) 250-4884
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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