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General NPI Number Information
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NPI Number | 1508308107
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Entity Type | Organization
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Legal Business Name | ALTUS TREATMENT SERVICES
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 145 COLUMBIA
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City | ALISO VIEJO
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State | CA
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Zip | 92656-1413
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Country | US
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Telephone | 949-521-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 145 COLUMBIA
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City | ALISO VIEJO
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State | CA
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Zip | 92656-1413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATION OFFICER
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Name | BENJAMIN CLAY NILES III
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Credential |
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Telephone | 949-521-6138
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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 | 300650CP
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300650BP
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300650DP
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License Number State | CA
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