SEPULVEDA ACC METH PHARMACY (4123)    INSTITUTION (4)

Name Value
NAME SEPULVEDA ACC METH PHARMACY
STATE CALIFORNIA
STREET ADDR. 1 16111 PLUMMER STREET
CITY SEPULVEDA
ZIP 91343-2036
OFFICIAL VA NAME SEPULVEDA AMB CARE CTR METHADONE PHARM
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME SEPULVEDA AMBULATORY CARE CENTER (METHADONE PHARMACY)
ST. ADDR. 1 (MAILING) 16111 PLUMMER STREET
CITY (MAILING) SEPULVEDA
STATE (MAILING) CALIFORNIA
ZIP (MAILING) 91343-2036
EFFECTIVE DATE/TIME
  • 2008-02-06 00:00:00
    STATUS:   ACTIVE
    NPI:   1003864851
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE PACIFIC
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA