Provider Demographics
NPI:1922451574
Name:CHABAD OF CALIFORNIA
Entity Type:Organization
Organization Name:CHABAD OF CALIFORNIA
Other - Org Name:CHABAD TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KOVI
Authorized Official - Last Name:BLAUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-965-1365
Mailing Address - Street 1:1750 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4602
Mailing Address - Country:US
Mailing Address - Phone:323-965-1365
Mailing Address - Fax:
Practice Address - Street 1:1750 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4602
Practice Address - Country:US
Practice Address - Phone:323-965-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190087DN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190087DNOtherSTATE LICENSE