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General NPI Number Information
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NPI Number | 1710371950
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Entity Type | Organization
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Legal Business Name | OCTLC, INC.
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 125 S CHAPARRAL CT STE 200
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City | ANAHEIM
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State | CA
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Zip | 92808-2263
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Country | US
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Telephone | 818-636-2938
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Fax | 833-930-2303
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Provider Business Mailing Address
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Address Line | 3943 IRVINE BLVD # 5
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City | IRVINE
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State | CA
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Zip | 92602-2400
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Country | US
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Telephone | 818-636-2938
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SAYEH SEYEDFATHI
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Credential |
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Telephone | 818-636-2938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 306004787
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License Number State | CA
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