Provider Demographics
NPI:1902941875
Name:BLESSED DRUG&ALCOHOL TREATMENT AND RESEARCH PROGRAM INC.
Entity Type:Organization
Organization Name:BLESSED DRUG&ALCOHOL TREATMENT AND RESEARCH PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:UGOCHUKWU
Authorized Official - Last Name:ANUSIEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-971-1325
Mailing Address - Street 1:8407 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3423
Mailing Address - Country:US
Mailing Address - Phone:323-971-1325
Mailing Address - Fax:323-971-1365
Practice Address - Street 1:8407 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3423
Practice Address - Country:US
Practice Address - Phone:323-971-1325
Practice Address - Fax:323-971-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190402AP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7064Medicaid