Provider Demographics
NPI:1497134423
Name:TARZANA TREATMENT CENTER
Entity Type:Organization
Organization Name:TARZANA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:CAADE
Authorized Official - Phone:562-428-4111
Mailing Address - Street 1:5190 ATANTIC AVE.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805
Mailing Address - Country:US
Mailing Address - Phone:562-428-4111
Mailing Address - Fax:562-984-5610
Practice Address - Street 1:5190 ATANTIC AVE.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4588
Practice Address - Country:US
Practice Address - Phone:562-428-4111
Practice Address - Fax:562-984-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital