Organization
RENEWED SPOT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN EVANS (COO)
(850) 241-4196
Entity
Organization
Contact information
Practice address
819 W 54TH ST, LOS ANGELES, CA 90037-3615
(850) 241-4196
Mailing address
819 W 54TH ST, LOS ANGELES, CA 90037-3615
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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