| Desire 4 Change Living Iop | |
|
17019 San Jose St Granada Hills CA 91344-6238 | |
| (310) 345-9618 | |
| Not Available |
| Full Name | Desire 4 Change Living Iop |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 17019 San Jose St, Granada Hills, California |
| Authorized Official Name and Position | Kimberlee Saffore (EXECUTIVE PROGRAM DIRECTOR) |
| Authorized Official Contact | 3103459618 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desire 4 Change Living Iop 17019 San Jose St Granada Hills CA 91344-6238 Ph: () - | Desire 4 Change Living Iop 17019 San Jose St Granada Hills CA 91344-6238 Ph: (310) 345-9618 |
| NPI Number | 1548708365 |
|---|---|
| Provider Enumeration Date | 02/01/2017 |
| Last Update Date | 04/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548708365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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