MEDICARE: DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER

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
1	261Q00000X	Clinic/Center	96000148	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CMM71096F	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1457398539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER

Provider Business Mailing Address
First Line	:	19300 RINALDI ST
Second Line	:	SUITE 8270
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1651
Country	:	US
Telephone Number	:	310-628-9512
Fax Number	:	818-392-5025

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2388
Country	:	US
Telephone Number	:	310-628-9512
Fax Number	:	818-804-4043

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. EDNA ELIZABETH MILLER
Credential	:
Telephone Number	:	310-628-9512

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	03/03/2008

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Directions to “DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER ” Practice Location

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