Basic Information
| Provider Information | |||||||||
| NPI: | 1265891121 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADOLESCENT TREATMENT CENTERS, INC AND THUNDER ROAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 40TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946092633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106535040 | ||||||||
| FaxNumber: | 5106536475 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 40TH ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946092633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106535040 | ||||||||
| FaxNumber: | 5106536475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2016 | ||||||||
| LastUpdateDate: | 02/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | SVOBODA | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 5106535040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.