Provider Demographics
NPI:1093701534
Name:DUAL DIAGNOSIS ASSESMENT AND TREATMENT CENTER INC
Entity Type:Organization
Organization Name:DUAL DIAGNOSIS ASSESMENT AND TREATMENT CENTER INC
Other - Org Name:HEALTH CARE DUAL DIAGNOSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-804-4043
Mailing Address - Street 1:19300 RINALDI STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-9998
Mailing Address - Country:US
Mailing Address - Phone:818-804-4043
Mailing Address - Fax:818-804-4047
Practice Address - Street 1:19300 RINALDI ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-1651
Practice Address - Country:US
Practice Address - Phone:310-628-9512
Practice Address - Fax:818-831-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55000015261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71075FOtherMEDI-CAL