NPIMap

Organization Active NPI

Immaculate Care Center Inc

  • Addiction (Substance Use Disorder) Counselor
  • Los Angeles, CA
National Provider Identifier
1275669871
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
190479AN Issued in CA
Legal business name
IMMACULATE CARE CENTER INC
Practice address
3540 Wilshire Blvd
Suite 818
Los Angeles, CA 90010-2307
Phone
(213) 383-1124
Fax
(213) 383-0261
NPI assigned
Feb 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Godday E. Imakavar
Title
Executive Director
Phone
(213) 383-1124

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 190479AN CA Primary

Addresses

Primary practice location

3540 Wilshire Blvd
Suite 818
Los Angeles, CA 90010-2307

Mailing address

3540 Wilshire Blvd
Suite 818
Los Angeles, CA 90010-2307
Phone (213) 383-1124

Other identifiers 1

IdentifierTypeStateIssuer
190479ANOtherCAADP

National Provider Directory

National Provider Directory
Tax ID family
Immaculate Care Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275669871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 WILSHIRE BLVD",
            "address_2": "SUITE 818",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102307",
            "telephone_number": "213-383-1124",
            "fax_number": "213-383-0261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 WILSHIRE BLVD",
            "address_2": "SUITE 818",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900102307",
            "telephone_number": "213-383-1124",
            "fax_number": "213-383-0261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IMAKAVAR",
        "authorized_official_first_name": "GODDAY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "213-383-1124",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "190479AN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADP",
            "identifier": "190479AN",
            "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 Aug 22, 2020; 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.