1073603338 NPI number — THE CENTER FOR THE TREATMENT OF ADDICTION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073603338 NPI number — THE CENTER FOR THE TREATMENT OF ADDICTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR THE TREATMENT OF ADDICTION
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:
6
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:
1073603338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 E COMMONWEALTH AVE STE J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92831-4635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-992-1677
Provider Business Mailing Address Fax Number:
714-992-4906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 E COMMONWEALTH AVE STE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92831-4635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-992-1677
Provider Business Practice Location Address Fax Number:
714-992-4906
Provider Enumeration Date:
10/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABNEY
Authorized Official First Name:
JEANETTE
Authorized Official Middle Name:
CAROLTRICE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
714-992-1677

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  00000000000000 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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