Basic Information
| Provider Information | |||||||||
| NPI: | 1730308867 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NARCOTIC ADDICTION TREATMENT AGENCY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8741 LAUREL CANYON BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913522919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187685525 | ||||||||
| FaxNumber: | 8187685530 | ||||||||
| Practice Location | |||||||||
| Address1: | 8741 LAUREL CANYON BLVD | ||||||||
| Address2: | |||||||||
| City: | SUN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913522919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187685525 | ||||||||
| FaxNumber: | 8187685530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 01/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | D'ANDRIA | ||||||||
| AuthorizedOfficialFirstName: | GENCO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2143793300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 19-150 | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7128 | 01 | CA | METHADONE CLINIC | OTHER |