NPIMap

Organization Active NPI

La Fuente Hollywood Treatment Center LLC

  • Substance Abuse Rehabilitation Facility
  • Los Angeles, CA
National Provider Identifier
1073887329
Registry record updated Mar 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
190725AP Issued in CA
Legal business name
LA FUENTE HOLLYWOOD TREATMENT CENTER LLC
Practice address
5718 Fountain Ave
Los Angeles, CA 90028-8516
Phone
(323) 464-2947
Fax
(323) 366-9339
NPI assigned
Mar 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2012

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

Authorized official

Name
Manuel Rodriguez
Title
Executive Director
Phone
(323) 464-2947

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 190725AP CA Primary

Addresses

Primary practice location

5718 Fountain Ave
Los Angeles, CA 90028-8516

Mailing address

5718 Fountain Ave
Los Angeles, CA 90028-8516
Phone (323) 464-2947

Other names 1

  • La Fuente Hollywood Treatment Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2064248La Fuente Hollywood Treatment Center5718 Fountain Ave, Los Angeles, CA 90028Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
La Fuente Hollywood Treatment Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1073887329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5718 FOUNTAIN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900288516",
            "telephone_number": "323-464-2947",
            "fax_number": "323-366-9339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5718 FOUNTAIN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900288516",
            "telephone_number": "323-464-2947",
            "fax_number": "323-366-9339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA FUENTE HOLLYWOOD TREATMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-05",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "MANUEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "323-464-2947"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190725AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Fuente Hollywood Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.