Organization
L. A.SOUTH HEALTH SERVIES
Active
Organization
L. A.SOUTH HEALTH SERVIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW E ETUK COUNSELOR (EXCUTUVE DIRECTOR)
(323) 751-0608
Entity
Organization
Contact information
Practice address
1704 W MANCHESTER AVE, SUITE 205, LOS ANGELES, CA 90047-3034
(323) 751-0608
(323) 751-0375
Mailing address
1704 W MANCHESTER AVE, SUITE 205, LOS ANGELES, CA 90047-3034
(323) 751-0608
(323) 751-0375
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
190476AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190476AN
DRUG REHABILITATION CLINI
CA
Enumeration date
03/13/2007
Last updated
08/22/2020
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