NPIMap

Organization Active NPI

Revive Detox

  • Substance Abuse Rehabilitation Facility
  • Los Angeles, CA
National Provider Identifier
1639561566
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
190836AP Issued in CA
Legal business name
REVIVE DETOX
Practice address
360 N Vista St
Los Angeles, CA 90036-5739
Phone
(818) 462-3824
NPI assigned
Mar 2, 2015
Last updated
Mar 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Mr. Matthew Conley
Title
Program Director
Phone
(818) 462-3824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 190836AP CA Primary

Addresses

Primary practice location

360 N Vista St
Los Angeles, CA 90036-5739

Mailing address

360 N Vista St
Los Angeles, CA 90036-5739
Phone (818) 462-3824

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1639561566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 N VISTA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900365739",
            "telephone_number": "818-462-3824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 N VISTA ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900365739",
            "telephone_number": "818-462-3824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "CONLEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "818-462-3824",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190836AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 2, 2015; 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.