Provider Demographics
NPI:1962245928
Name:DETOX TREATMENT CENTER
Entity type:Organization
Organization Name:DETOX TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHBALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-666-9229
Mailing Address - Street 1:1700 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4316
Mailing Address - Country:US
Mailing Address - Phone:310-666-9229
Mailing Address - Fax:
Practice Address - Street 1:1607 S GARTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3605
Practice Address - Country:US
Practice Address - Phone:310-666-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility