Provider Demographics
NPI:1851548556
Name:TRTC OUTPATIENT DRUG TREATMENT
Entity Type:Organization
Organization Name:TRTC OUTPATIENT DRUG TREATMENT
Other - Org Name:THE RANCH AT TOPANGA CANYON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BATHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-455-4555
Mailing Address - Street 1:22287 MULHOLLAND HWY STE 136
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5157
Mailing Address - Country:US
Mailing Address - Phone:310-455-4555
Mailing Address - Fax:
Practice Address - Street 1:22287 MULHOLLAND HWY STE 136
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5157
Practice Address - Country:US
Practice Address - Phone:310-455-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45231261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder