Provider Demographics
NPI:1255078747
Name:SCOTTS VALLEY TREATMENT CENTER INC
Entity type:Organization
Organization Name:SCOTTS VALLEY TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-533-2870
Mailing Address - Street 1:1005 PARALLEL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5709
Mailing Address - Country:US
Mailing Address - Phone:707-533-2870
Mailing Address - Fax:707-263-4345
Practice Address - Street 1:3250 GUERNEVILLE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4030
Practice Address - Country:US
Practice Address - Phone:707-579-1603
Practice Address - Fax:707-284-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit