1689701401 NPI number — CADA DETOX

Table of content: (NPI 1689701401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689701401 NPI number — CADA DETOX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CADA DETOX
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689701401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 28
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93102-0028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-963-1836
Provider Business Mailing Address Fax Number:
805-965-3871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 PLACIDO AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-963-1836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOTTLIEB
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
805-722-1314

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  420022AN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 420022EN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)