Provider Demographics
NPI:1619333002
Name:INTEGRITY TREATMENT PROGRAM, LLC
Entity Type:Organization
Organization Name:INTEGRITY TREATMENT PROGRAM, LLC
Other - Org Name:RECOVER INTEGRITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YESHAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-294-9030
Mailing Address - Street 1:12301 WILSHIRE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1000
Mailing Address - Country:US
Mailing Address - Phone:310-294-9030
Mailing Address - Fax:
Practice Address - Street 1:12301 WILSHIRE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1000
Practice Address - Country:US
Practice Address - Phone:310-294-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)