Healthcare Provider Details

I. General information

NPI: 1437247087
Provider Name (Legal Business Name): CDT SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/20/2024
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6371 AUBURN BLVD STE A
CITRUS HEIGHTS CA
95621
US

IV. Provider business mailing address

11230 GOLD EXPRESS DR # 310-353
GOLD RIVER CA
95670-4484
US

V. Phone/Fax

Practice location:
  • Phone: 916-723-1319
  • Fax: 866-336-7276
Mailing address:
  • Phone: 916-784-1149
  • Fax: 866-336-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number340039AP
License Number StateCA

VIII. Authorized Official

Name: MR. ROSS S. MORTON
Title or Position: CHIEF OPERATING OFFICER
Credential: JD
Phone: 916-784-1149