Provider Demographics
NPI:1528229879
Name:REBUILD CALIFORNIA ALLIANCE
Entity type:Organization
Organization Name:REBUILD CALIFORNIA ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEANTWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-422-1124
Mailing Address - Street 1:7662 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-2346
Mailing Address - Country:US
Mailing Address - Phone:323-422-1124
Mailing Address - Fax:323-920-7380
Practice Address - Street 1:145 W 99TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-4114
Practice Address - Country:US
Practice Address - Phone:323-422-1124
Practice Address - Fax:323-531-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059125Medicare Oscar/Certification