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General NPI Number Information
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NPI Number | 1730306499
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Entity Type | Organization
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Legal Business Name | ANTELOPE VALLEY REHABILITATION CENTERS
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 44900 60TH ST W CHP TRAILER
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City | LANCASTER
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State | CA
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Zip | 93536-7618
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Country | US
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Telephone | 661-945-8458
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Fax | 661-945-8248
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Provider Business Mailing Address
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Address Line | PO BOX 25
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City | ACTON
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State | CA
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Zip | 93510-0025
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Country | US
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Telephone | 661-269-0062
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Fax | 661-269-0427
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Authorized Official
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Title or Position | INTERIM EXECUTIVE DIRECTOR
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Name | GREG HASELTINE
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Credential |
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Telephone | 661-269-0074
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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 |
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License Number State |
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