Healthcare Provider Details

I. General information

NPI: 1134510290
Provider Name (Legal Business Name): CALIFORNIA ADDICTION TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15986 HIGHLAND SPRINGS AVENUE
BANNING CA
92220-6508
US

IV. Provider business mailing address

300 S HIGHLAND SPRINGS AVE SUITE 6C #185
BANNING CA
92220-6504
US

V. Phone/Fax

Practice location:
  • Phone: 951-972-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BORKOWSKI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 954-487-1224