Provider Demographics
NPI:1639763006
Name:DETOUR BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:DETOUR BEHAVIORAL HEALTH, INC.
Other - Org Name:DETOUR TRANSITIONS OUTPATIENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LOEBS
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-CAS
Authorized Official - Phone:626-802-8287
Mailing Address - Street 1:2542 E FLORENCE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4774
Mailing Address - Country:US
Mailing Address - Phone:626-473-0344
Mailing Address - Fax:626-473-0345
Practice Address - Street 1:2677 ZOE AVENUE
Practice Address - Street 2:SUITE 301, 302, 303B
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-372-1281
Practice Address - Fax:323-372-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder