Provider Demographics
NPI:1437582186
Name:CANON HUMAN SERVICES CENTERS INC
Entity Type:Organization
Organization Name:CANON HUMAN SERVICES CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-249-9097
Mailing Address - Street 1:9705 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3031
Mailing Address - Country:US
Mailing Address - Phone:323-249-9097
Mailing Address - Fax:323-249-9121
Practice Address - Street 1:9705 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3031
Practice Address - Country:US
Practice Address - Phone:323-249-9097
Practice Address - Fax:323-249-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190099EN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility