Provider Demographics
NPI:1114197076
Name:PALMS RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:PALMS RESIDENTIAL CARE FACILITY
Other - Org Name:MT. CARMEL OUTPATIENT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-759-0340
Mailing Address - Street 1:801 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5218
Mailing Address - Country:US
Mailing Address - Phone:323-759-0340
Mailing Address - Fax:323-759-0466
Practice Address - Street 1:801 W 70TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5218
Practice Address - Country:US
Practice Address - Phone:323-759-0340
Practice Address - Fax:323-759-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder