Provider Demographics
NPI:1023475274
Name:THE SALVATION ARMY
Entity type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-264-3618
Mailing Address - Street 1:180 E OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4709
Mailing Address - Country:US
Mailing Address - Phone:562-264-3618
Mailing Address - Fax:562-264-3718
Practice Address - Street 1:5600 RICKENBACKER RD
Practice Address - Street 2:2A/B
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-6418
Practice Address - Country:US
Practice Address - Phone:323-263-1206
Practice Address - Fax:323-263-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190023CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility