Provider Demographics
NPI:1407092406
Name:FLORENCE DRUG & ALCOHOL TREATMENT CENTER
Entity Type:Organization
Organization Name:FLORENCE DRUG & ALCOHOL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLISHCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-915-1761
Mailing Address - Street 1:9671 N. SUNLAND BLVD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-9998
Mailing Address - Country:US
Mailing Address - Phone:818-915-1761
Mailing Address - Fax:
Practice Address - Street 1:9671 N. SUNLAND BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-9998
Practice Address - Country:US
Practice Address - Phone:818-915-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management