Provider Demographics
NPI:1417378514
Name:CALIFORNIA DRUG TREATMENT PROGRAM
Entity Type:Organization
Organization Name:CALIFORNIA DRUG TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZE
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC
Authorized Official - Phone:323-756-9933
Mailing Address - Street 1:9001 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4835
Mailing Address - Country:US
Mailing Address - Phone:323-756-9933
Mailing Address - Fax:323-756-9515
Practice Address - Street 1:9001 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4835
Practice Address - Country:US
Practice Address - Phone:323-756-9933
Practice Address - Fax:323-756-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1275668105251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275668105OtherMEDICAL