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General NPI Number Information
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NPI Number | 1427043389
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Entity Type | Organization
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Legal Business Name | TARZANA TREATMENT CENTERS, INC.
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 8330 RESEDA BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4619
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Country | US
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Telephone | 818-654-3911
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Fax | 818-996-3051
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Provider Business Mailing Address
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Address Line | 18646 OXNARD ST
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City | TARZANA
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State | CA
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Zip | 91356-1411
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Country | US
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Telephone | 818-654-3911
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Fax | 818-996-3051
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Authorized Official
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Title or Position | DIRECTOR OF INFORMATION TECHNOLOGY
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Name | JIM SORG
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Credential |
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Telephone | 818-654-3911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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