Provider Demographics
NPI:1780814640
Name:DIXON RECOVERY INSTITUTE, INC.
Entity Type:Organization
Organization Name:DIXON RECOVERY INSTITUTE, INC.
Other - Org Name:CENTRAL HIGH SCHOOL'S SOJOURNER TRUTH CLASSROOM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:323-988-3744
Mailing Address - Street 1:4715 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1233
Mailing Address - Country:US
Mailing Address - Phone:323-988-3744
Mailing Address - Fax:323-988-9672
Practice Address - Street 1:4066 W 17TH ST
Practice Address - Street 2:MODULE #1 & 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-6025
Practice Address - Country:US
Practice Address - Phone:323-988-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIXON RECOVERY INSTITUTE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190622AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7336OtherDRUG MEDI-CAL