Provider Demographics
NPI:1659324408
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 INTEGRATED SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DD, PSY ED
Authorized Official - Phone:310-256-8809
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:310-256-8809
Mailing Address - Fax:
Practice Address - Street 1:2600 N CENTRAL AVE
Practice Address - Street 2:B1
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1640
Practice Address - Country:US
Practice Address - Phone:888-417-5163
Practice Address - Fax:888-316-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X, 261QM0850X, 261QM0855X, 261QR0405X, 261QS1000X
CA96000148261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71096FOtherMEDI CAL DEPT OF HUMAN SV
CACMM71096FOtherMEDI CAL DEPT OF HUMAN SV