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General NPI Number Information
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NPI Number | 1881735587
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Entity Type | Organization
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Legal Business Name | CDT SERVICE CORPORATION
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 6380 WELLS AVE
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City | LOOMIS
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State | CA
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Zip | 95650-9302
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Country | US
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Telephone | 916-784-1149
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Fax | 866-336-7276
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Provider Business Mailing Address
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Address Line | 11230 GOLD EXPRESS DR # 310-353
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City | GOLD RIVER
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State | CA
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Zip | 95670-4484
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Country | US
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Telephone | 916-784-1149
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Fax | 866-356-7299
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Authorized Official
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Title or Position | CEO
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Name | ROSS STUART MORTON
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Credential |
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Telephone | 916-784-1149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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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 | 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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