Provider Demographics
NPI:1083035240
Name:CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE
Entity Type:Organization
Organization Name:CALIFORNIA HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE
Other - Org Name:PALOMA RECOVERY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERMEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPLESSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:323-722-4529
Mailing Address - Street 1:3316-3322 W. BEVERLY BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-722-4529
Mailing Address - Fax:323-722-4450
Practice Address - Street 1:328 N AVENUE 59
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3408
Practice Address - Country:US
Practice Address - Phone:323-257-9227
Practice Address - Fax:323-257-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191801407324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA191801407OtherDEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING