Organization
CNV DETOX INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID MARVIN (CHIEF EXECUTIVE OFFICER)
(310) 592-0139
Entity
Organization
Contact information
Practice address
5919 W 74TH ST, LOS ANGELES, CA 90045-1601
(310) 431-4829
Mailing address
PO BOX 9848, MARINA DEL REY, CA 90295-2248
(310) 592-0139
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/16/2018
Last updated
09/15/2021
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