Provider Demographics
NPI:1609286699
Name:LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE
Entity Type:Organization
Organization Name:LOS ANGELES CENTERS FOR ALCOHOL AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEWEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-906-2676
Mailing Address - Street 1:11015 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4601
Mailing Address - Country:US
Mailing Address - Phone:562-906-2676
Mailing Address - Fax:562-906-2681
Practice Address - Street 1:470 E 3RD ST
Practice Address - Street 2:A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1629
Practice Address - Country:US
Practice Address - Phone:213-626-6411
Practice Address - Fax:213-626-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190100EN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190100ENOtherDEPARTMENT HEALTH CARE SERVICES CERTIFICATION NUMBER
CA197564Medicaid