Basic Information
| Provider Information | |||||||||
| NPI: | 1649910365 | ||||||||
| 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: | 8186543815 | ||||||||
| FaxNumber: | 8189963051 | ||||||||
| Practice Location | |||||||||
| Address1: | 12021 WILMINGTON AVE STE 301 | ||||||||
| Address2: | BUILDING #18 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900593019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009961051 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2022 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | SENELLA | ||||||||
| AuthorizedOfficialFirstName: | ALBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/ CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8186543815 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TARZANA TREATMENT CENTERS, INC. | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.