Provider Demographics
NPI:1104010974
Name:PORTALS
Entity Type:Organization
Organization Name:PORTALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RELIEF STAFF
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-251-1969
Mailing Address - Street 1:6613 1/2 KING AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3975
Mailing Address - Country:US
Mailing Address - Phone:323-251-1969
Mailing Address - Fax:
Practice Address - Street 1:6613 1/2 KING AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3975
Practice Address - Country:US
Practice Address - Phone:323-251-1969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility