Basic Information
Provider Information | |||||||||
NPI: | 1467032599 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TARZANA TREATMENT CENTERS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 18646 OXNARD ST | ||||||||
Address2: |   | ||||||||
City: | TARZANA | ||||||||
State: | CA | ||||||||
PostalCode: | 913561411 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8186543815 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6005 YOLANDA AVE | ||||||||
Address2: |   | ||||||||
City: | TARZANA | ||||||||
State: | CA | ||||||||
PostalCode: | 913561421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8009961051 | ||||||||
FaxNumber: | 8189963051 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/13/2021 | ||||||||
LastUpdateDate: | 04/13/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SENELLA | ||||||||
AuthorizedOfficialFirstName: | ALBERT | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/ CHIEF EXECUTIVE OFFICER | ||||||||
AuthorizedOfficialTelephone: | 8186543815 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | TARZANA TREATMENT CENTERS, INC. | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/13/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.