Healthcare Provider Details

I. General information

NPI: 1306095948
Provider Name (Legal Business Name): WESTMINSTER TRC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 HOSPITAL CIR
WESTMINSTER CA
92683-3910
US

IV. Provider business mailing address

206 HOSPITAL CIR
WESTMINSTER CA
92683-3910
US

V. Phone/Fax

Practice location:
  • Phone: 714-895-1985
  • Fax:
Mailing address:
  • Phone: 714-895-1985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberLVN 128197
License Number StateCA

VIII. Authorized Official

Name: JANICE ERVIN-ASSIGAL
Title or Position: CHIEF SUPERVISOR
Credential: RN
Phone: 714-895-1985