Provider Demographics
NPI:1265761811
Name:REHOBOTH DRUG AND ALCOHOL PREVENTION CENTER
Entity type:Organization
Organization Name:REHOBOTH DRUG AND ALCOHOL PREVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEFEMI
Authorized Official - Middle Name:OLUFISAYO
Authorized Official - Last Name:ADEGBESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:310-663-0789
Mailing Address - Street 1:568 W COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3011
Mailing Address - Country:US
Mailing Address - Phone:310-663-0789
Mailing Address - Fax:310-627-9130
Practice Address - Street 1:568 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220
Practice Address - Country:US
Practice Address - Phone:310-663-0789
Practice Address - Fax:310-627-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3245S0500X
CA19DG3245S0500X
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0Medicaid
CA0000Medicare PIN