Provider Demographics
NPI:1750533287
Name:RESEDA SUBSTANCE ABUSE CENTER
Entity type:Organization
Organization Name:RESEDA SUBSTANCE ABUSE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERN
Authorized Official - Prefix:
Authorized Official - First Name:LEONDRA
Authorized Official - Middle Name:DANETTE
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-895-5002
Mailing Address - Street 1:8745 PARTHENIA PL
Mailing Address - Street 2:SUITENUMBER 4
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5166
Mailing Address - Country:US
Mailing Address - Phone:818-895-5002
Mailing Address - Fax:818-895-5502
Practice Address - Street 1:8745 PARTHENIA PL
Practice Address - Street 2:SUITENUMBER 4
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5166
Practice Address - Country:US
Practice Address - Phone:818-895-5002
Practice Address - Fax:818-895-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility