Basic Information
| Provider Information | |||||||||
| NPI: | 1548617053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE SALVATION ARMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 E OCEAN BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908024709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622643618 | ||||||||
| FaxNumber: | 5622643718 | ||||||||
| Practice Location | |||||||||
| Address1: | 11301 WILSHIRE BLVD | ||||||||
| Address2: | BUILDING 212 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900731003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2016 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIVISIONAL COMMANDER | ||||||||
| AuthorizedOfficialTelephone: | 5622643618 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 190023DN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.