Provider Demographics
NPI:1124140637
Name:CIRCLE OF FRIENDS OUTPATIENT SERVICES INC.
Entity type:Organization
Organization Name:CIRCLE OF FRIENDS OUTPATIENT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-465-5888
Mailing Address - Street 1:715 N RIDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3105
Mailing Address - Country:US
Mailing Address - Phone:323-465-5888
Mailing Address - Fax:
Practice Address - Street 1:715 N RIDGEWOOD PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3105
Practice Address - Country:US
Practice Address - Phone:323-465-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190272AP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02937706OtherTREATMENT FACILITY