Provider Demographics
NPI:1093493652
Name:CARRARA TREATMENT WELLNESS & SPA
Entity type:Organization
Organization Name:CARRARA TREATMENT WELLNESS & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-712-2153
Mailing Address - Street 1:1814 MARCHEETA PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1116
Mailing Address - Country:US
Mailing Address - Phone:424-421-6610
Mailing Address - Fax:213-334-4100
Practice Address - Street 1:1814 MARCHEETA PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-1116
Practice Address - Country:US
Practice Address - Phone:424-421-6610
Practice Address - Fax:213-334-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility