| Renew Integrated Program #2 | |
|
904 Willow Ave La Puente CA 91746-1615 | |
| (626) 931-3000 | |
| Not Available |
| Full Name | Renew Integrated Program #2 |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 904 Willow Ave, La Puente, California |
| Authorized Official Name and Position | Laja Ibraheem (CEO) |
| Authorized Official Contact | 5624263300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Integrated Program #2 4000 Long Beach Blvd # 228 Long Beach CA 90807-2617 Ph: (562) 426-3300 | Renew Integrated Program #2 904 Willow Ave La Puente CA 91746-1615 Ph: (626) 931-3000 |
| NPI Number | 1528292356 |
|---|---|
| Provider Enumeration Date | 05/07/2009 |
| Last Update Date | 05/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528292356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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