Provider Demographics
NPI:1417261983
Name:NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE OF EAST SAN GABRIEL
Entity Type:Organization
Organization Name:NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE OF EAST SAN GABRIEL
Other - Org Name:NCADD OF ESG & PV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-331-5316
Mailing Address - Street 1:4626 N. GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2055
Mailing Address - Country:US
Mailing Address - Phone:626-331-5316
Mailing Address - Fax:626-332-2219
Practice Address - Street 1:4626 NORTH GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2055
Practice Address - Country:US
Practice Address - Phone:626-331-5316
Practice Address - Fax:626-332-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190241CN101YA0400X
CA19-003-01-123101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty