Provider Demographics
NPI:1568917466
Name:WEST COUNTY MEDICAL
Entity Type:Organization
Organization Name:WEST COUNTY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSING NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:562-428-4222
Mailing Address - Street 1:100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5924
Mailing Address - Country:US
Mailing Address - Phone:562-428-4222
Mailing Address - Fax:562-428-0372
Practice Address - Street 1:100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5924
Practice Address - Country:US
Practice Address - Phone:562-428-4222
Practice Address - Fax:562-428-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1946Medicaid