| None | |
|
155 W Washington Blvd Suite 517 Los Angeles CA 90015-3552 | |
| (323) 304-0054 | |
| (213) 749-1540 |
| Full Name | None |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 155 W Washington Blvd, Los Angeles, California |
| Authorized Official Name and Position | Nii Ahuma Ocansey (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3233040054 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 155 West Washington Blvd S Suite 517 Los Angeles CA 90015-0000 Ph: (323) 304-0054 | None 155 W Washington Blvd Suite 517 Los Angeles CA 90015-3552 Ph: (323) 304-0054 |
| NPI Number | 1063632966 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 09/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063632966 | NPI | - | NPPES |
| 190451AN | Other | CA | PROVIDER NUMBER |
| 197131000 | Other | CA | MEDI-CAL PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 101YA0400X (California) | Primary |
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