Organization
SKYLINE RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ZEENA FOTEH N/A (ADMINISTRATOR)
(310) 686-9689
Entity
Organization
Contact information
Practice address
1517 S SEPULVEDA BLVD, LOS ANGELES, CA 90025-3311
(626) 319-6296
Mailing address
1517 S SEPULVEDA BLVD, LOS ANGELES, CA 90025-3311
(626) 319-6296
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
INSURERS
INSURERS
—
Enumeration date
02/20/2023
Last updated
06/13/2024
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