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General NPI Number Information
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NPI Number | 1619622495
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Entity Type | Organization
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Legal Business Name | TRU DETOX CENTER, INC.
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Dates
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Enumeration Date | 02/19/2022
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Last Update Date | 02/19/2022
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Provider Practice Location Address
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Address Line | 10437 SUNNYBRAE AVE
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City | CHATSWORTH
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State | CA
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Zip | 91311-2462
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Country | US
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Telephone | 818-687-0059
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Fax |
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Provider Business Mailing Address
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Address Line | 10437 SUNNYBRAE AVE
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City | CHATSWORTH
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State | CA
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Zip | 91311-2462
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Country | US
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Telephone | 818-687-0059
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA ROSE ELKOURY
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Credential |
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Telephone | 818-687-0059
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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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