Healthcare Provider Details

I. General information

NPI: 1386389443
Provider Name (Legal Business Name): CDT SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9381 E STOCKTON BLVD STE 102
ELK GROVE CA
95624-5069
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 916-914-6961
  • Fax:
Mailing address:
  • Phone: 916-784-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROSS STUART MORTON
Title or Position: CEO
Credential: JD
Phone: 916-784-1149