| Didi Hirsch Mhs - Via Avanta | |
|
11643 Glenoaks Blvd Pacoima CA 91331-1050 | |
| (818) 897-2609 | |
| (818) 890-7159 |
| Full Name | Didi Hirsch Mhs - Via Avanta |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 11643 Glenoaks Blvd, Pacoima, California |
| Authorized Official Name and Position | Dulce M Ruiz (CONTRACTS & GRANTS MANAGER) |
| Authorized Official Contact | 3107515442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Didi Hirsch Mhs - Via Avanta 4760 Sepulveda Blvd Culver City CA 90230-4820 Ph: (310) 390-6612 | Didi Hirsch Mhs - Via Avanta 11643 Glenoaks Blvd Pacoima CA 91331-1050 Ph: (818) 897-2609 |
| NPI Number | 1740539980 |
|---|---|
| Provider Enumeration Date | 09/04/2012 |
| Last Update Date | 10/08/2020 |
| Certification Date | 10/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740539980 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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