Healthcare Provider Details

I. General information

NPI: 1639558729
Provider Name (Legal Business Name): EL DORADO COMMUNITY SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24625 ARCH ST
NEWHALL CA
91321-1111
US

IV. Provider business mailing address

24625 ARCH ST
NEWHALL CA
91321-1111
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-2644
  • Fax:
Mailing address:
  • Phone: 661-288-2644
  • Fax: 661-288-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ANN BLANKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-254-6630