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General NPI Number Information
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NPI Number | 1255078747
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Entity Type | Organization
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Legal Business Name | SCOTTS VALLEY TREATMENT CENTER INC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3250 GUERNEVILLE RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-4030
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Country | US
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Telephone | 707-579-4066
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Fax | 707-284-1236
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Provider Business Mailing Address
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Address Line | PO BOX 4869
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City | SANTA ROSA
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State | CA
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Zip | 95402-4869
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Country | US
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Telephone | 707-284-1235
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Fax | 707-284-1236
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Authorized Official
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Title or Position | CEO
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Name | THOMAS J JORDAN
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Credential |
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Telephone | 707-349-8545
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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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