Provider Demographics
NPI:1972172310
Name:THURSTON DETOX LLC
Entity type:Organization
Organization Name:THURSTON DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-367-8727
Mailing Address - Street 1:11346 THURSTON PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2429
Mailing Address - Country:US
Mailing Address - Phone:828-367-8727
Mailing Address - Fax:310-861-1945
Practice Address - Street 1:11346 THURSTON PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2429
Practice Address - Country:US
Practice Address - Phone:828-367-8727
Practice Address - Fax:310-861-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility