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NPI Code Detail

MEDICARE: TARZANA TREATMENT CENTERS, INC.

MEDICARE: TARZANA TREATMENT CENTERS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2251X00000XSupports Brokerage Agency
3261QM1300XMulti-Specialty Clinic/Center
43336C0002XClinic Pharmacy
5324500000XSubstance Abuse Rehabilitation Facility190085NNCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1054148OTHERCANPPES OSCAR CORRECTION

General Provider Information

NPI Number : 1003941683
Entity Type Code : Organization
Provider Name (Legal Business Name) : TARZANA TREATMENT CENTERS, INC.
Provider Business Mailing Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1411
Country : US
Telephone Number : 818-996-1051
Fax Number :
Provider Business Practice Location Address
First Line : 5190 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-6510
Country : US
Telephone Number : 818-996-1051
Fax Number :
Authorized Official
Title or Position : PRESIDENT/ CHIEF EXECUTIVE OFFICER
Name : ALBERT SENELLA
Credential :
Telephone Number : 818-654-3815
Provider Enumeration Date : 02/22/2007
Last Update Date : 02/07/2022

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