Healthcare Provider Details

I. General information

NPI: 1093701534
Provider Name (Legal Business Name): DUAL DIAGNOSIS ASSESMENT AND TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19300 RINALDI ST
NORTHRIDGE CA
91326-1651
US

IV. Provider business mailing address

19300 RINALDI STREET
NORTHRIDGE CA
91327-9998
US

V. Phone/Fax

Practice location:
  • Phone: 310-628-9512
  • Fax: 818-831-3416
Mailing address:
  • Phone: 818-804-4043
  • Fax: 818-804-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number55000015
License Number StateCA

VIII. Authorized Official

Name: MS. EDNA ELIZABETH MILLER
Title or Position: PRESIDENT
Credential:
Phone: 818-804-4043