NPIMap

Organization Active NPI

Shatto Street

  • Community/Behavioral Health Agency
  • Los Angeles, CA
National Provider Identifier
1053687160
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
190622AN Issued in CA
Legal business name
SHATTO STREET
Practice address
1543 Shatto St
Los Angeles, CA 90017-1718
Phone
(213) 353-4407
NPI assigned
Mar 23, 2012
Organization subpart
Yes
Parent organization
DIXON RECOVERY INSTITUTE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronda Renee Dixon, JD
Title
Executive Director
Phone
(323) 988-3744

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 190622AN CA Primary

Addresses

Primary practice location

1543 Shatto St
Los Angeles, CA 90017-1718

Mailing address

4715 Crenshaw Blvd
Los Angeles, CA 90043-1233
Phone (323) 988-3744

Other identifiers 1

IdentifierTypeStateIssuer
197336MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Hope Street13 organizations share this tax ID, including this one
Part of
Hope Street

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1543 Shatto St
Los Angeles, CA 90017
Phone (213) 353-4407

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1053687160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4715 CRENSHAW BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900431233",
            "telephone_number": "323-988-3744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1543 SHATTO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171718",
            "telephone_number": "213-353-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHATTO STREET",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIXON RECOVERY INSTITUTE, INC.",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "RONDA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "323-988-3744",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "190622AN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197336",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.