Basic Information
| Provider Information | |||||||||
| NPI: | 1790906907 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TARZANZA TREATMENT CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TTC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 W LANCASTER BLVD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617262630 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 907 W LANCASTER BLVD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617262630 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FUGITT | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
| AuthorizedOfficialMiddleName: | JUNE | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNSELOR 1 | ||||||||
| AuthorizedOfficialTelephone: | 6617262630 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCDC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.