Healthcare Provider Details

I. General information

NPI: 1619702099
Provider Name (Legal Business Name): TARZANA TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 E PALMDALE BLVD
PALMDALE CA
93550-4745
US

IV. Provider business mailing address

18646 OXNARD ST
TARZANA CA
91356-1411
US

V. Phone/Fax

Practice location:
  • Phone: 800-996-1051
  • Fax: 818-996-3051
Mailing address:
  • Phone: 800-996-1051
  • Fax: 818-996-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERT SENELLA
Title or Position: PRESIDENT/ CHIEF EXECUTIVE OFFICER
Credential:
Phone: 818-654-3815