Provider Demographics
NPI:1225440613
Name:DREW EDMUND PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:DREW EDMUND PSYCHIATRIC CENTER
Other - Org Name:AFFINITYTREATMENT CENTERS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-917-1112
Mailing Address - Street 1:2035 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7017
Mailing Address - Country:US
Mailing Address - Phone:760-917-1112
Mailing Address - Fax:619-924-9931
Practice Address - Street 1:2035 ALTA VISTA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7017
Practice Address - Country:US
Practice Address - Phone:760-917-1112
Practice Address - Fax:619-924-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320600000X
CA374601463320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness