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11821 FOOTHILL BLVD
NPI 1164767356
Counselor - Addiction (Substance Use Disorder) in Los Angeles, CA

Active since November 29, 2012
5436 S. BROADWAY, LOS ANGELES, CA 90037(818) 694-7206 Get Directions Write a Review

NPPES record last updated: November 29, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About 11821 Foothill Blvd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

11821 FOOTHILL BLVD (NPI 1164767356) is a healthcare organization registered as an addiction (substance use disorder) in Los Angeles, California and active in the NPI registry since November 2012. The organization lists Derrick Bradley Fortune, Counselor, as its authorized official.

NPPES Registry Identity

NPI1164767356
Entity TypeOrganization
Primary Taxonomy101YA0400X
Legal Business Name11821 FOOTHILL BLVD
Location Address5436 S. BROADWAYLos Angeles, CA 90037
Mailing Address11821 Foothill Blvd # K35Lake View Terrace, CA 91342-7200 · (818) 694-7206
Phone(818) 694-7206
Organization SubpartNo
Authorized OfficialDerrick Bradley FortuneCounselor · (818) 694-7206
Enumeration DateNovember 29, 2012
✔ NPI 1164767356 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
5436 S. BROADWAY, Los Angeles, CA 90037
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 11821 Foothill Blvd's NPI number?

The NPI number for 11821 Foothill Blvd is 1164767356. It was assigned to this organization in the NPPES registry on November 29, 2012.

Where is 11821 Foothill Blvd located?

11821 Foothill Blvd is located at 5436 S. Broadway, Los Angeles, CA 90037. The listed phone number is (818) 694-7206.

What is 11821 Foothill Blvd's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for 11821 Foothill Blvd was last updated on November 29, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.