Provider Demographics
NPI:1104045293
Name:WILLIAM H. DAVIS TREATMENT CENTER
Entity Type:Organization
Organization Name:WILLIAM H. DAVIS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:CDS, RAS
Authorized Official - Phone:661-223-5590
Mailing Address - Street 1:1607 E PALMDALE BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-7801
Mailing Address - Country:US
Mailing Address - Phone:661-223-5590
Mailing Address - Fax:661-538-9057
Practice Address - Street 1:1607 E PALMDALE BLVD STE G
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7801
Practice Address - Country:US
Practice Address - Phone:661-223-5590
Practice Address - Fax:661-538-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility