LA FUENTE HOLLYWOOD TREATMENT CENTER
NPI 1073887329
Substance Abuse Rehabilitation Facility in Los Angeles, CA
- Organization
- Substance Abuse Rehabilitation Facility
- CLIA Number: 05D2064248
- CLIA Cert. Type: Other - DRUG ALCOHOL TREATMENT CT
- CLIA Exp. Date: 08-15-2027
About LA FUENTE HOLLYWOOD TREATMENT CENTER
This page provides the complete NPI Profile along with additional information for La Fuente Hollywood Treatment Center, a provider established in Los Angeles, California operating as a Substance Abuse Rehabilitation Facility. The healthcare provider is registered in the NPI registry with number 1073887329 assigned on March 2012. The practitioner's primary taxonomy code is 324500000X with license number 190725AP (CA). The provider is registered as an organization and their NPI record was last updated 14 years ago. The provider's is doing business as La Fuente Hollywood Treatment Center. The authorized official of this NPI record is Manuel Rodriguez (Executive Director)
- NPI
- 1073887329 Verify this NPI
- Provider Legal Name
- LA FUENTE HOLLYWOOD TREATMENT CENTER LLC
- Other Organization Name
- LA FUENTE HOLLYWOOD TREATMENT CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 5718 FOUNTAIN AVE LOS ANGELES, CA 90028
- Location Phone
- (323) 464-2947
- Location Fax
- (323) 366-9339
- Mailing Address
- 5718 FOUNTAIN AVE LOS ANGELES, CA 90028
- Mailing Phone
- (323) 464-2947
- Mailing Fax
- (323) 366-9339
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-05-2012
- Last Update Date
- 03-05-2012
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Substance Abuse Rehabilitation Facility
- Taxonomy Code
- 324500000X
- Type
- Residential Treatment Facilities
- License No.
- 190725AP
- License State
- CA
- Taxonomy Description
- A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 05D2064248
- Facility Type
- Other - DRUG ALCOHOL TREATMENT CT
- Certificate Effective Date
- August 16, 2025
- Certificate Expiration Date
- August 15, 2027
- Laboratory Director
- RODNEY COLLINS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to La Fuente Hollywood Treatment Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1073887329, enumerated as an "organization" on March 05, 2012.
The provider is located at 5718 FOUNTAIN AVE LOS ANGELES, CA 90028 and the phone number is (323) 464-2947.
Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.
