Basic Information
| Provider Information | |||||||||
| NPI: | 1497809735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOENIX HOUSES OF LOS ANGELES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 OCEAN FRONT WALK | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902912403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103923070 | ||||||||
| FaxNumber: | 3103929068 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 OCEAN FRONT WALK | ||||||||
| Address2: | |||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902912403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103923070 | ||||||||
| FaxNumber: | 3103929068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 11/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | ABBASSI | ||||||||
| AuthorizedOfficialFirstName: | POURIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT, REGIONAL DIRECT | ||||||||
| AuthorizedOfficialTelephone: | 8186863000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.E. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 190115AN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.