MEDICARE: CDT SERVICE CORPORATION

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1487513123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDT SERVICE CORPORATION

Provider Business Mailing Address
First Line	:	11230 GOLD EXPRESS DR # 310-353
Second Line	:
City	:	GOLD RIVER
State	:	CA
Zip	:	95670-4484
Country	:	US
Telephone Number	:	916-784-1149
Fax Number	:	866-336-7276

Provider Business Practice Location Address
First Line	:	6490 S MCCARRAN BLVD STE 41
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-6126
Country	:	US
Telephone Number	:	775-964-4898
Fax Number	:	866-336-7276

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROSS MORTON
Credential	:	JD
Telephone Number	:	916-784-1149

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “CDT SERVICE CORPORATION ” Practice Location

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