Healthcare Provider Details

I. General information

NPI: 1174109128
Provider Name (Legal Business Name): CLEAN TREATMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HODENCAMP RD STE 205
THOUSAND OAKS CA
91360-5834
US

IV. Provider business mailing address

123 HODENCAMP RD STE 205
THOUSAND OAKS CA
91360-5834
US

V. Phone/Fax

Practice location:
  • Phone: 213-700-6050
  • Fax:
Mailing address:
  • Phone: 818-436-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: IRENE BRIDGETT HYDER
Title or Position: FOUNDER
Credential:
Phone: 213-700-6050