Provider Demographics
NPI:1619256369
Name:CONSCIOUS LIVING TREATMENT CENTER
Entity Type:Organization
Organization Name:CONSCIOUS LIVING TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR & SPONSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:A JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-235-9141
Mailing Address - Street 1:10787 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:818-235-9142
Mailing Address - Fax:443-588-2995
Practice Address - Street 1:10787 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:818-235-9142
Practice Address - Fax:443-588-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility