Provider Demographics
NPI:1154822088
Name:EMBRASSE TREATMENT CENTER PC
Entity Type:Organization
Organization Name:EMBRASSE TREATMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TWEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-864-5663
Mailing Address - Street 1:550 W VISTA WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5735
Mailing Address - Country:US
Mailing Address - Phone:760-295-8727
Mailing Address - Fax:
Practice Address - Street 1:550 W VISTA WAY STE 102
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5735
Practice Address - Country:US
Practice Address - Phone:760-295-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122488261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder