Basic Information
| Provider Information | |||||||||
| NPI: | 1619106747 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TARZANA TREATMENT CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18646 OXNARD ST | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913561411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009961051 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44443 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935343346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009961051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2009 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | SORG | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF INFORMATION TECHNOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 8186543911 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 190085JN | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 190085JN | 01 | CA | CALIFORNIA DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS CERTIFICATION | OTHER | CMM70739F | 05 | CA | MEDICAID |