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General NPI Number Information
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NPI Number | 1679094031
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Entity Type | Organization
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Legal Business Name | TRC TREATMENT CENTER LLC
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 07/06/2017
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Provider Practice Location Address
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Address Line | 11150 W OLYMPIC BLVD STE 775
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City | LOS ANGELES
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State | CA
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Zip | 90064-1850
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Country | US
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Telephone | 424-835-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 WESTWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-2109
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Country | US
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Telephone |
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Fax | 310-280-0107
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | ADAM B. ZAGHA
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Credential |
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Telephone | 424-835-6506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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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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