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General NPI Number Information
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NPI Number | 1902258908
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Entity Type | Organization
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Legal Business Name | SO CAL TREATMENT OUTPATIENT
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 2166 W BROADWAY #134
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City | ANAHEIM
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State | CA
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Zip | 92804-2446
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Country | US
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Telephone | 714-381-0432
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Fax | 714-333-4866
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Provider Business Mailing Address
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Address Line | 546 S CITRON ST
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City | ANAHEIM
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State | CA
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Zip | 92805-4420
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Country | US
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Telephone | 714-381-0432
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Fax | 714-333-4866
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Authorized Official
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Title or Position | CEO
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Name | TRINA TIMANUS
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Credential |
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Telephone | 714-381-0432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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