Provider Demographics
NPI:1184859548
Name:DIXON RECOVERY INSTITUTE, INC.
Entity Type:Organization
Organization Name:DIXON RECOVERY INSTITUTE, INC.
Other - Org Name:DRI/ANIMO LOCKE 3 CHARTER HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/POSITION
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:323-244-5677
Mailing Address - Street 1:4715 CRENSHAW BLVD
Mailing Address - Street 2:#14
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1233
Mailing Address - Country:US
Mailing Address - Phone:323-244-5677
Mailing Address - Fax:323-988-9672
Practice Address - Street 1:325 E 111TH ST
Practice Address - Street 2:RMS. 241 & 327
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-3003
Practice Address - Country:US
Practice Address - Phone:323-244-5677
Practice Address - Fax:323-988-9672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIXON RECOVERY INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-28
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190622AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197336OtherDRUG MEDI-CAL