Healthcare Provider Details

I. General information

NPI: 1881735587
Provider Name (Legal Business Name): CDT SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/04/2021
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 WELLS AVE
LOOMIS CA
95650-9302
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 916-784-1149
  • Fax: 866-336-7276
Mailing address:
  • Phone: 916-784-1149
  • Fax: 866-356-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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