MEDICARE: DELTA TREATMENT CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility
3	3245S0500X	Children's Substance Abuse Rehabilitation Facility
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1124793799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	23679 CALABASAS RD UNIT 954
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 LAS VIRGENES RD
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-2642
Country	:	US
Telephone Number	:	951-858-9858
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. VICTORIA BOONE
Credential	:
Telephone Number	:	951-858-9858

Provider Enumeration Date	:	08/14/2021
Last Update Date	:	08/14/2021

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