Provider Demographics
NPI:1790903904
Name:CALIFORNIA HEALTH, ALCOHOL &. DRUG EDUCATION PROGRAM, INC.
Entity Type:Organization
Organization Name:CALIFORNIA HEALTH, ALCOHOL &. DRUG EDUCATION PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:NZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-833-8426
Mailing Address - Street 1:3756 SANTA ROSALIA DR. STE. 423
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3614
Mailing Address - Country:US
Mailing Address - Phone:323-294-7662
Mailing Address - Fax:323-294-7703
Practice Address - Street 1:3756 SANTA ROSALIA DR. STE. 423
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3614
Practice Address - Country:US
Practice Address - Phone:323-294-7662
Practice Address - Fax:323-294-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2737106251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197015000OtherMEDI-CAL