Provider Demographics
NPI:1356660633
Name:DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-590-4537
Mailing Address - Street 1:19300 RINALDI ST
Mailing Address - Street 2:STE. 8270
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1651
Mailing Address - Country:US
Mailing Address - Phone:310-590-4537
Mailing Address - Fax:310-590-4538
Practice Address - Street 1:601 S ACACIA AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3702
Practice Address - Country:US
Practice Address - Phone:310-590-4537
Practice Address - Fax:310-590-4538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71096FOtherMEDI-CAL