Provider Demographics
NPI:1326386327
Name:MBRACE TREATMENT INC.
Entity Type:Organization
Organization Name:MBRACE TREATMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:MEG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHAMBAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-694-5590
Mailing Address - Street 1:10533 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-694-5590
Mailing Address - Fax:310-694-3278
Practice Address - Street 1:10533 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-694-5590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health