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General NPI Number Information
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NPI Number | 1689884595
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Entity Type | Organization
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Legal Business Name | STATE HEALTH CARE DUAL DIAGNOSIS
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1145 W HEDGES AVE
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City | FRESNO
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State | CA
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Zip | 93728-1219
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Country | US
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Telephone | 310-628-9512
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Fax | 818-804-4047
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Provider Business Mailing Address
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Address Line | 19300 RINALDI ST STE 8270
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City | NORTHRIDGE
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State | CA
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Zip | 91326-1651
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Country | US
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Telephone | 310-628-9512
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Fax | 818-804-4047
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EDNA MILLER
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Credential |
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Telephone | 310-628-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 100056AP
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License Number State | CA
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