Organization
WEST COAST DRUG & ALCOHOL PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMALIA MASTRODOMENICO (COUNSELOR)
(818) 908-1740
Entity
Organization
Contact information
Practice address
6850 VAN NUYS BLVD, SUITE 125, VAN NUYS, CA 91405-4640
(818) 908-1740
(818) 908-3336
Mailing address
6850 VAN NUYS BLVD, SUITE 125, VAN NUYS, CA 91405-4640
(818) 908-1740
(818) 908-3336
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/15/2013
Last updated
08/15/2013
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