Provider Demographics
NPI:1710268263
Name:SOUTHWEST TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHWEST TREATMENT CENTER, INC.
Other - Org Name:SOUTHWEST COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:OSHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:310-603-6555
Mailing Address - Street 1:349 W COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3110
Mailing Address - Country:US
Mailing Address - Phone:310-603-6555
Mailing Address - Fax:310-603-6565
Practice Address - Street 1:349 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3110
Practice Address - Country:US
Practice Address - Phone:310-603-6555
Practice Address - Fax:310-603-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care