Healthcare Provider Details

I. General information

NPI: 1790906907
Provider Name (Legal Business Name): TARZANZA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W LANCASTER BLVD
LANCASTER CA
93534-2305
US

IV. Provider business mailing address

907 W LANCASTER BLVD
LANCASTER CA
93534-2305
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax:
Mailing address:
  • Phone: 661-726-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FRANCES JUNE FUGITT
Title or Position: COUNSELOR 1
Credential: CCDC
Phone: 661-726-2630