Provider Demographics
NPI:1376761361
Name:CALIFORNIA DRUG TREATMENT PROGRAM, INC.
Entity Type:Organization
Organization Name:CALIFORNIA DRUG TREATMENT PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSAYANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHAZEBAMWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-747-0054
Mailing Address - Street 1:915 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3311
Mailing Address - Country:US
Mailing Address - Phone:213-747-0054
Mailing Address - Fax:213-747-9515
Practice Address - Street 1:915 W WASHINGTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3311
Practice Address - Country:US
Practice Address - Phone:213-747-0054
Practice Address - Fax:213-747-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder