Basic Information
| Provider Information | |||||||||
| NPI: | 1114167491 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY ALCOHOL & DRUG TREATMENT FOUNDATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VAN NUYS TREATMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15015 OXNARD ST | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914112613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187874151 | ||||||||
| FaxNumber: | 8187872840 | ||||||||
| Practice Location | |||||||||
| Address1: | 370 CRENSHAW BLVD STE E100 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905031728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187874151 | ||||||||
| FaxNumber: | 8187872840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MACIAS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | JADE | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8187874151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY ALCOHOL & DRUG TREATMENT FOUNDATION | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | B.A. LIBERAL STUDIES | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 197090 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.