Provider Demographics
NPI:1568709103
Name:AMERICAN DRUG RECOVERY PROGRAM INC.
Entity type:Organization
Organization Name:AMERICAN DRUG RECOVERY PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EHIGIMETOR
Authorized Official - Middle Name:
Authorized Official - Last Name:INEGBENOISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-759-3464
Mailing Address - Street 1:2724 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-5143
Mailing Address - Country:US
Mailing Address - Phone:323-759-3464
Mailing Address - Fax:323-759-3427
Practice Address - Street 1:1618 W 184TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3803
Practice Address - Country:US
Practice Address - Phone:323-759-3464
Practice Address - Fax:323-759-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190530AP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health