Healthcare Provider Details

I. General information

NPI: 1992339451
Provider Name (Legal Business Name): CDT SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8078 ORANGE AVE
FAIR OAKS CA
95628-5941
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 916-671-3937
  • Fax: 866-336-7276
Mailing address:
  • Phone: 916-784-1149
  • Fax: 866-336-7276

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