Organization
COMMUNITY CLINIC AND HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN WALLACE (CEO)
(818) 651-4594
Entity
Organization
Contact information
Practice address
6715 MELROSE AVE, LOS ANGELES, CA 90038-3411
(818) 601-5878
Mailing address
6715 MELROSE AVE, LOS ANGELES, CA 90038-3411
(818) 601-5878
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
538463
CA
Other
Enumeration date
12/03/2014
Last updated
12/03/2014
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