Provider Demographics
NPI:1700896511
Name:CRC HEALTH JEFF GRAND TREATMENT CENTER
Entity Type:Organization
Organization Name:CRC HEALTH JEFF GRAND TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BATTALIA
Authorized Official - Suffix:
Authorized Official - Credentials:BA RASI
Authorized Official - Phone:213-747-7267
Mailing Address - Street 1:3130 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007
Mailing Address - Country:US
Mailing Address - Phone:213-747-7267
Mailing Address - Fax:213-747-4835
Practice Address - Street 1:3130 S HILL ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:213-747-7267
Practice Address - Fax:213-747-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADP19010261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone