Provider Demographics
NPI:1326314212
Name:CENTER FOR DISCOVERY & ADOLESCENT CHANGE
Entity Type:Organization
Organization Name:CENTER FOR DISCOVERY & ADOLESCENT CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARMINIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-828-1800
Mailing Address - Street 1:4281 KATELLA AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3588
Mailing Address - Country:US
Mailing Address - Phone:714-828-1800
Mailing Address - Fax:714-828-1869
Practice Address - Street 1:4281 KATELLA AVE STE 111
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3588
Practice Address - Country:US
Practice Address - Phone:714-828-1800
Practice Address - Fax:714-828-1868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH HOLDINGS II, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001593323P00000X
CA980001602323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility