Provider Demographics
NPI:1497809735
Name:PHOENIX HOUSES OF LOS ANGELES, INC.
Entity Type:Organization
Organization Name:PHOENIX HOUSES OF LOS ANGELES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT, REGIONAL DIRECT
Authorized Official - Prefix:MR
Authorized Official - First Name:POURIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:PE
Authorized Official - Phone:818-686-3000
Mailing Address - Street 1:503 OCEAN FRONT WALK
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2403
Mailing Address - Country:US
Mailing Address - Phone:310-392-3070
Mailing Address - Fax:310-392-9068
Practice Address - Street 1:503 OCEAN FRONT WALK
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2403
Practice Address - Country:US
Practice Address - Phone:310-392-3070
Practice Address - Fax:310-392-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190115AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility