Healthcare Provider Details

I. General information

NPI: 1548813009
Provider Name (Legal Business Name): CDT SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 SHERRY DR
ORANGEVALE CA
95662-4534
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 916-987-1410
  • Fax:
Mailing address:
  • Phone: 916-784-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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