| Men's Community Re-entry Program | |
|
631-a Maple Avenue Los Angeles CA 90014-2211 | |
| (213) 673-3002 | |
| (213) 626-2458 |
| Full Name | Men's Community Re-entry Program |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 631-a Maple Avenue, Los Angeles, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Men's Community Re-entry Program 510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | Men's Community Re-entry Program 631-a Maple Avenue Los Angeles CA 90014-2211 Ph: (213) 673-3002 |
| NPI Number | 1205387776 |
|---|---|
| Provider Enumeration Date | 10/20/2016 |
| Last Update Date | 08/30/2022 |
| Certification Date | 08/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205387776 | NPI | - | NPPES |
| 7995 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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