Provider Demographics
NPI:1528366861
Name:DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:DUAL DIAGNOSIS ASSESSMENT AND TREATMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-628-9512
Mailing Address - Street 1:PO BOX 8270
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-8270
Mailing Address - Country:US
Mailing Address - Phone:866-417-5163
Mailing Address - Fax:310-733-1180
Practice Address - Street 1:16550 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:866-417-5163
Practice Address - Fax:310-733-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center