Provider Demographics
NPI:1609006683
Name:COMMUNITY ALCOHOL & DRUG FOUNDATION
Entity Type:Organization
Organization Name:COMMUNITY ALCOHOL & DRUG FOUNDATION
Other - Org Name:VAN NUYS TX CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:BA LIBERAL STUDIES
Authorized Official - Phone:818-787-4151
Mailing Address - Street 1:15015 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2613
Mailing Address - Country:US
Mailing Address - Phone:818-787-4151
Mailing Address - Fax:818-787-2840
Practice Address - Street 1:5200 IRWINDALE AVE
Practice Address - Street 2:
Practice Address - City:IRWINDALE
Practice Address - State:CA
Practice Address - Zip Code:91706-2097
Practice Address - Country:US
Practice Address - Phone:818-787-4151
Practice Address - Fax:818-787-2840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA WORKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAADP197099251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health