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General NPI Number Information
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NPI Number | 1639558729
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Entity Type | Organization
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Legal Business Name | EL DORADO COMMUNITY SERVICE CENTER
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 24625 ARCH ST
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City | NEWHALL
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State | CA
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Zip | 91321-1111
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Country | US
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Telephone | 661-288-2644
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Fax |
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Provider Business Mailing Address
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Address Line | 24625 ARCH ST
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City | NEWHALL
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State | CA
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Zip | 91321-1111
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Country | US
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Telephone | 661-288-2644
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Fax | 661-288-2669
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CYNTHIA ANN BLANKS
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Credential |
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Telephone | 661-254-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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