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General NPI Number Information
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NPI Number | 1174109128
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Entity Type | Organization
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Legal Business Name | CLEAN TREATMENT CENTER, INC.
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Dates
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Enumeration Date | 03/21/2021
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 123 HODENCAMP RD STE 205
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5834
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Country | US
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Telephone | 213-700-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 123 HODENCAMP RD STE 205
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5834
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Country | US
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Telephone | 818-436-2231
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | IRENE BRIDGETT HYDER
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Credential |
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Telephone | 213-700-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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