Provider Demographics
NPI:1417313214
Name:DEDICATO TREATMENT CENTER INC
Entity Type:Organization
Organization Name:DEDICATO TREATMENT CENTER INC
Other - Org Name:DEDICATO TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O./CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MA,CATCV
Authorized Official - Phone:626-921-0113
Mailing Address - Street 1:22 W CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-1219
Mailing Address - Country:US
Mailing Address - Phone:626-921-0113
Mailing Address - Fax:626-921-0214
Practice Address - Street 1:133 N ALTADENA DR STE 401
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7330
Practice Address - Country:US
Practice Address - Phone:626-921-0113
Practice Address - Fax:626-921-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit