Provider Demographics
NPI:1124394549
Name:DUAL DIAGNOSIS TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:DUAL DIAGNOSIS TREATMENT CENTER, INC.
Other - Org Name:SOVEREIGN BY THE SEA I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONMOY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-416-1205
Mailing Address - Street 1:PO BOX 5915
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-5915
Mailing Address - Country:US
Mailing Address - Phone:949-625-0376
Mailing Address - Fax:949-390-9899
Practice Address - Street 1:601 CALLE REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2624
Practice Address - Country:US
Practice Address - Phone:302-354-9310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility