Provider Demographics
NPI:1851501225
Name:C-CONRAD GROUP LIMITED, INC.
Entity Type:Organization
Organization Name:C-CONRAD GROUP LIMITED, INC.
Other - Org Name:INSPIRATION OUTPATIENT ALCOHOL AND DRUG TX PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-487-5710
Mailing Address - Street 1:8929 S SEPULVEDA BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3634
Mailing Address - Country:US
Mailing Address - Phone:310-410-0278
Mailing Address - Fax:
Practice Address - Street 1:8929 SOUTH SEPULVEDA BOULEVARD, SUITE 410
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5109
Practice Address - Country:US
Practice Address - Phone:310-410-0278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health