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6455 Coldwater Canyon Ave North Hollywood CA 91606-1112 | |
| (818) 779-5212 | |
| (818) 779-5167 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6455 Coldwater Canyon Ave, North Hollywood, California |
| Authorized Official Name and Position | Susan Ann Berman (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 8187795212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13130 Burbank Blvd Sherman Oaks CA 91401-6037 Ph: (818) 779-5212 | 6455 Coldwater Canyon Ave North Hollywood CA 91606-1112 Ph: (818) 779-5212 |
| NPI Number | 1720112188 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720112188 | NPI | - | NPPES |
| 7489 | Other | CA | MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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