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940 Avenue 64 Pasadena CA 91105-2711 | |
| (323) 254-2274 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 940 Avenue 64, Pasadena, California |
| Authorized Official Name and Position | Marisol M Lara (QA MANAGER ADMINISTRATION) |
| Authorized Official Contact | 3232542274 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
940 Avenue 64 Pasadena CA 91105-2711 Ph: (323) 254-2274 | 940 Avenue 64 Pasadena CA 91105-2711 Ph: (323) 254-2274 |
| NPI Number | 1750415162 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750415162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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