DMHLAC EOB PMRT SA5 (NPI# 1144593518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144593518 |
| Entity Type | Organization |
| Organization Name | DMHLAC EOB PMRT SA5 |
| Practice Address |
11303 W, Olympic Boulevard Los Angeles CA 90066 |
| Mailing Address |
11303 W, Olympic Blvd, 2nd Floor Los Angeles CA 90066 |
| Practice Telephone | 3104823260 |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2012-02-16 |
| Authorized Official Name | MONICA RODRIGUEZ-FINSTON (BRANCH SUPERVISOR) |
| Authorized Official Telephone | 3104823260 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 390200000 | CA | Residential Treatment Facilities |
| Street Address |
11303 W, OLYMPIC BOULEVARD |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194330274 | Marilyn S Zweifach | Psychologist | 3606 Barry Avenue, Los Angeles, CA 90066 | 2020-09-15 |
| 1073167458 | Rosario Tabares | Marriage & Family Therapist | 4173 Inglewood Blvd., Los Angeles, CA 90066 | 2019-07-24 |
| 1396200739 | Ruzziel Pio | Licensed Vocational Nurse | 4344 Harding Avenue, Los Angeles, CA 90066 | 2019-02-08 |
| 1164992731 | Erfan Nazeri | Student in an Organized Health Care Education/Training Program | 3101 Sawtelle Blvd, Apt 128, Los Angeles, CA 90066 | 2018-11-27 |
| 1972096600 | Tricia Kim Ann Walters | Licensed Vocational Nurse | 1233 S. La Cienega Blvd, Los Angeles, CA 90066 | 2018-06-07 |
| 1174015622 | Nicole Hiorns | Occupational Therapist | 11605 Washington Place, Los Angeles, CA 90066 | 2018-05-31 |
| 1225549934 | Gary Sattler | Psychoanalyst | 3133 Federal Ave., Los Angeles, CA 90066 | 2017-10-20 |
| 1669991568 | Nexus Recovery Services, LLC | Clinic/Center | 11515 Washington Blvd, Culver City, CA 90066 | 2017-09-12 |
| 1336669381 | Andrea Michelle Bakke | Dentist | 3636 Rosewood Ave, Los Angeles, CA 90066 | 2017-06-21 |
| 1659820686 | Pegah Ghassemi Bakhtiari Dds Inc | Dentist | 12756 West Washington Blvd, Los Angeles, CA 90066 | 2016-10-03 |
| Find all providers in zip 90066 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386283984 | Aptus Pacem, LLC | Community Based Residential Treatment Facility, Mental Illness | 5035 E Echo St, Los Angeles, CA 90042-3915 | 2019-12-30 |
| 1023578705 | Mindful Growth Foundation | Community Based Residential Treatment Facility, Mental Illness | 1208 W 38th St, Los Angeles, CA 90037-1106 | 2019-03-20 |
| 1114491636 | Mindful Growth Foundation | Community Based Residential Treatment Facility, Mental Illness | 3924 W Adams Blvd, Los Angeles, CA 90018-1755 | 2019-01-17 |
| 1467963256 | Special Service for Groups, Inc. | Community Based Residential Treatment Facility, Mental Illness | 2178 Firestone Blvd, Los Angeles, CA 90002 | 2017-10-19 |
| 1184169815 | Exodus Recovery, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3754-56 Overland Ave, Los Angeles, CA 90034-6312 | 2017-01-04 |
| 1205262748 | Reese's Board and Care Home | Community Based Residential Treatment Facility, Mental Illness | 11205 Monitor Ave, Los Angeles, CA 90059-1935 | 2013-09-16 |
| 1093152076 | Bridges To Recovery IIii | Community Based Residential Treatment Facility, Mental Illness | 10201 Charing Cross Rd, Los Angeles, CA 90024-1814 | 2013-05-30 |
| 1104199033 | Adrienne James | Community Based Residential Treatment Facility, Mental Illness | 3776 S Gramercy Pl, One Half, Los Angeles, CA 90018-4377 | 2012-02-23 |
| 1396014544 | Bridges To Recovery IIi | Community Based Residential Treatment Facility, Mental Illness | 777 Sarbonne Rd, Los Angeles, CA 90077-3320 | 2011-12-16 |
| 1912225855 | South Central Residential Care #2 | Community Based Residential Treatment Facility, Mental Illness | 1551 W 80th St, Los Angeles, CA 90047-2839 | 2010-05-15 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90066 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.