Basic Information
| Provider Information | |||||||||
| NPI: | 1396804225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STRAIGHT TALK CLINIC, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STRAIGHT TALK GERRY HOUSE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3785 S. PLAZA DRIVE | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148282000 | ||||||||
| FaxNumber: | 7148282006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 & 1227 W 6TH STREET | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149721402 | ||||||||
| FaxNumber: | 7149721519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHROTH | ||||||||
| AuthorizedOfficialFirstName: | JANINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7148282000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STRAIGHT TALK CLINIC, INC. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 300040BN | CA | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.