Provider Demographics
NPI:1265892079
Name:DIXON RECOVERY INSTITUTE, INC.
Entity type:Organization
Organization Name:DIXON RECOVERY INSTITUTE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-593-6660
Mailing Address - Street 1:3860 AMBERLY DR
Mailing Address - Street 2:UNIT D
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-3431
Mailing Address - Country:US
Mailing Address - Phone:866-593-6660
Mailing Address - Fax:866-593-6660
Practice Address - Street 1:1512 W SLAUSON AVE
Practice Address - Street 2:RMS. 103, 202 & 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1230
Practice Address - Country:US
Practice Address - Phone:866-593-6660
Practice Address - Fax:866-593-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190622AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health