Interconnection Center Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

190383AN Issued in CA

Legal business name

INTERCONNECTION CENTER INC.

Practice address

3833 S Grand Ave
Los Angeles, CA 90037-1311

Phone

(213) 747-4626

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Rudy Butler

Title

Excutive Director

Phone

(213) 747-4626

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grand Avenue Center For Dignity Other name

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902024276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3833 S GRAND AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900371311",
            "telephone_number": "213-747-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3833 S GRAND AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900371311",
            "telephone_number": "213-747-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCONNECTION CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "RUDY",
        "authorized_official_title_or_position": "EXCUTIVE DIRECTOR",
        "authorized_official_telephone_number": "213-747-4626",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190383AN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE REHAB",
            "identifier": "6893",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Avenue Center For Dignity",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• 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.