Provider Demographics
NPI:1629470190
Name:LOS ANGELES ATHLETIC ALTERNATIVE PROGRAM
Entity Type:Organization
Organization Name:LOS ANGELES ATHLETIC ALTERNATIVE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-204-1980
Mailing Address - Street 1:8450 HIGUERA ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2520
Mailing Address - Country:US
Mailing Address - Phone:310-204-1980
Mailing Address - Fax:310-204-6864
Practice Address - Street 1:8450 HIGUERA ST
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2520
Practice Address - Country:US
Practice Address - Phone:310-204-1980
Practice Address - Fax:310-204-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty