Provider Demographics
NPI:1518169325
Name:COVENANT HOUSE CALIFORNIA
Entity Type:Organization
Organization Name:COVENANT HOUSE CALIFORNIA
Other - Org Name:CHILDREN'S HOSPITAL LA COVENANT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:323-461-3131
Mailing Address - Street 1:1325 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5615
Mailing Address - Country:US
Mailing Address - Phone:323-461-3131
Mailing Address - Fax:323-957-6491
Practice Address - Street 1:1325 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5615
Practice Address - Country:US
Practice Address - Phone:323-461-3131
Practice Address - Fax:323-957-7419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-04
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management