Organization
ULTIMATE LIFESTYLE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MASHA LISITSA MFT (CEO)
(323) 290-0200
Entity
Organization
Contact information
Practice address
5012 S LA BREA AVE, LOS ANGELES, CA 90056-1863
(323) 290-0200
Mailing address
5012 S LA BREA AVE, LOS ANGELES, CA 90056-1863
(323) 290-0200
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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