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1509 Wilson Ter Glendale CA 91206-4007 | |
| (818) 409-8000 | |
| (818) 546-5600 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1509 Wilson Ter, Glendale, California |
| Authorized Official Name and Position | Kevin Roberts (CEO/PRESIDENT) |
| Authorized Official Contact | 8184098289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1509 Wilson Ter Glendale CA 91206-4007 Ph: (818) 409-8000 | 1509 Wilson Ter Glendale CA 91206-4007 Ph: (818) 409-8000 |
| NPI Number | 1336138403 |
|---|---|
| Provider Enumeration Date | 10/20/2005 |
| Last Update Date | 08/16/2017 |
| Medicare PECOS PAC ID | 4284692096 |
|---|---|
| Medicare Enrollment ID | O20130727000017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336138403 | NPI | - | NPPES |
| HSM30067F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 930000059 (California) | Primary |
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