Organization
LA DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELLIOTT LIEBHARD (CEO)
(917) 374-4215
Entity
Organization
Contact information
Practice address
4901 AMIGO AVE, TARZANA, CA 91356-4505
(917) 374-4215
Mailing address
4901 AMIGO AVE, TARZANA, CA 91356-4505
(917) 374-4215
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/10/2020
Last updated
01/10/2020
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