Healthcare Provider Details

I. General information

NPI: 1881710887
Provider Name (Legal Business Name): TARZANA TREATMENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 BAIRD AVE
RESEDA CA
91335-4150
US

IV. Provider business mailing address

18646 OXNARD ST
TARZANA CA
91356-1411
US

V. Phone/Fax

Practice location:
  • Phone: 818-342-5897
  • Fax:
Mailing address:
  • Phone: 818-996-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JIM SORG
Title or Position: IT DIRECTOR
Credential:
Phone: 818-654-3911