Provider Demographics
NPI:1154785475
Name:BLVD CENTERS, INC
Entity type:Organization
Organization Name:BLVD CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-550-2211
Mailing Address - Street 1:PO BOX 512030
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0030
Mailing Address - Country:US
Mailing Address - Phone:855-277-5363
Mailing Address - Fax:
Practice Address - Street 1:1316 SE 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3604
Practice Address - Country:US
Practice Address - Phone:951-323-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLVD CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-12
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility