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General NPI Number Information
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NPI Number | 1851548556
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Entity Type | Organization
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Legal Business Name | TRTC OUTPATIENT DRUG TREATMENT
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 22287 MULHOLLAND HWY STE 136
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City | CALABASAS
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State | CA
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Zip | 91302-5157
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Country | US
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Telephone | 310-455-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 22287 MULHOLLAND HWY STE 136
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City | CALABASAS
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State | CA
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Zip | 91302-5157
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Country | US
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Telephone | 310-455-4555
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | CHRISTOPHER JAMES BATHUM
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Credential |
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Telephone | 310-455-4555
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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 | A45231
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License Number State | CA
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