Healthcare Provider Details

I. General information

NPI: 1679094031
Provider Name (Legal Business Name): TRC TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 W OLYMPIC BLVD STE 775
LOS ANGELES CA
90064-1850
US

IV. Provider business mailing address

2315 WESTWOOD BLVD
LOS ANGELES CA
90064-2109
US

V. Phone/Fax

Practice location:
  • Phone: 424-835-6506
  • Fax:
Mailing address:
  • Phone:
  • Fax: 310-280-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ADAM B. ZAGHA
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 424-835-6506