Active NPI
Kyle Williams
- Children's Substance Abuse Rehabilitation Facility
- Whittier, CA
National Provider Identifier
1578879607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Children's Substance Abuse Rehabilitation Facility
- License
- 237228780
- Practice address
- 12322 Clearglen Ave
Whittier, CA 90604-3872 - Phone
- (562) 242-1076
- Fax
- (562) 947-4053
- NPI assigned
- Aug 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Children's Substance Abuse Rehabilitation Facility | 3245S0500X | 237228780 | CA | Primary |
Addresses
Primary practice location
12322 Clearglen Ave
Whittier, CA 90604-3872
Mailing address
12322 Clearglen Ave
Whittier, CA 90604-3872
Phone (562) 242-1076
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 237228780 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scadp/Awakenings | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Disabilities Residential Treatment Facility
- Whittier, CA
- NPI 1740515428
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282780800000",
"number": "1578879607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12322 CLEARGLEN AVE",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906043872",
"telephone_number": "562-242-1076",
"fax_number": "562-947-4053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12322 CLEARGLEN AVE",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906043872",
"telephone_number": "562-242-1076",
"fax_number": "562-947-4053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "KYLE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-26",
"last_updated": "2010-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "3245S0500X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
"state": "CA",
"license": "237228780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Whittier, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.