Provider Demographics
NPI:1912117938
Name:CALIFORNIA INSTITUTE OF HEALTH & SOCIAL SERVICES, INC
Entity Type:Organization
Organization Name:CALIFORNIA INSTITUTE OF HEALTH & SOCIAL SERVICES, INC
Other - Org Name:ENLIGHTENMENT CHEMICAL DEPENDENCY PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REG ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-645-5227
Mailing Address - Street 1:8929 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3616
Mailing Address - Country:US
Mailing Address - Phone:310-645-5227
Mailing Address - Fax:310-645-0833
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:SUITE 628
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-293-8771
Practice Address - Fax:310-645-0833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA INSTITUTE OF HEALTH & SOCIAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health