MEDICARE: TRTC OUTPATIENT DRUG TREATMENT

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	A45231	CA

General Provider Information

NPI Number	:	1851548556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRTC OUTPATIENT DRUG TREATMENT

Provider Business Mailing Address
First Line	:	22287 MULHOLLAND HWY STE 136
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-5157
Country	:	US
Telephone Number	:	310-455-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	22287 MULHOLLAND HWY STE 136
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-5157
Country	:	US
Telephone Number	:	310-455-4555
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	CHRISTOPHER JAMES BATHUM
Credential	:
Telephone Number	:	310-455-4555

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/25/2008

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