Provider Demographics
NPI:1841214269
Name:LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Entity Type:Organization
Organization Name:LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Other - Org Name:FORENSIC OUTPATIENT PROGRAM - TOWER I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:213-738-4601
Mailing Address - Street 1:550 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:213-738-4601
Mailing Address - Fax:213-386-1297
Practice Address - Street 1:450 BAUCHET ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2907
Practice Address - Country:US
Practice Address - Phone:213-473-6183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6701Medicaid