Provider Demographics
NPI:1710371950
Name:OCTLC, INC.
Entity Type:Organization
Organization Name:OCTLC, INC.
Other - Org Name:SUSTAIN RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYEDFATHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-636-2938
Mailing Address - Street 1:3943 IRVINE BLVD # 5
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2400
Mailing Address - Country:US
Mailing Address - Phone:818-636-2938
Mailing Address - Fax:
Practice Address - Street 1:125 S CHAPARRAL CT STE 200
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2263
Practice Address - Country:US
Practice Address - Phone:818-636-2938
Practice Address - Fax:833-930-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3060047873245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children