Provider Demographics
NPI:1922668441
Name:CORE MELROSE LLC
Entity Type:Organization
Organization Name:CORE MELROSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-931-9700
Mailing Address - Street 1:8302 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5404
Mailing Address - Country:US
Mailing Address - Phone:323-351-1790
Mailing Address - Fax:
Practice Address - Street 1:8302 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-5404
Practice Address - Country:US
Practice Address - Phone:323-351-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder