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11633 Hawthorne Blvd Ste 215 Hawthorne CA 90250-2322 | |
| (310) 675-7892 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 11633 Hawthorne Blvd Ste 215, Hawthorne, California |
| Authorized Official Name and Position | Teddy Idehen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3106757892 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11633 Hawthorne Blvd Ste 215 Hawthorne CA 90250-2322 Ph: (310) 675-7892 | 11633 Hawthorne Blvd Ste 215 Hawthorne CA 90250-2322 Ph: (310) 675-7892 |
| NPI Number | 1801013990 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801013990 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | RI-I0509270844 (California) | Primary |
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