Provider Demographics
NPI:1720411564
Name:WEST COAST DRUG & ALCOHOL PROGRAM
Entity Type:Organization
Organization Name:WEST COAST DRUG & ALCOHOL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRODOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-908-1740
Mailing Address - Street 1:6850 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4640
Mailing Address - Country:US
Mailing Address - Phone:818-908-1740
Mailing Address - Fax:818-908-3336
Practice Address - Street 1:6850 VAN NUYS BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4640
Practice Address - Country:US
Practice Address - Phone:818-908-1740
Practice Address - Fax:818-908-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility