Provider Demographics
NPI:1447755301
Name:LOS ANGELES RECOVERY CENTERS
Entity Type:Organization
Organization Name:LOS ANGELES RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-892-0535
Mailing Address - Street 1:3409 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4524
Mailing Address - Country:US
Mailing Address - Phone:323-797-5464
Mailing Address - Fax:
Practice Address - Street 1:3409 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4524
Practice Address - Country:US
Practice Address - Phone:323-632-7399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility