Provider Demographics
NPI:1437440542
Name:DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Other - Org Name:HEALTH CARE ENRICHMENT, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DD, PSY ED
Authorized Official - Phone:310-628-9512
Mailing Address - Street 1:PO BOX 92619
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-2619
Mailing Address - Country:US
Mailing Address - Phone:310-628-9512
Mailing Address - Fax:
Practice Address - Street 1:1984 OBISPO AVE
Practice Address - Street 2:STE. 1A
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1234
Practice Address - Country:US
Practice Address - Phone:310-628-9512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71069FMedicaid