NPIMap

Antelope Valley Community Clinic

Organization Active NPI Substance Abuse Rehabilitation Facility · Palmdale, CA

NPI 1154840320 · NPPES record last updated May 23, 2019

Key facts

NPI
1154840320
Entity type
Organization (NPI type 2)
Primary specialty
Substance Abuse Rehabilitation Facility 324500000X
Legal business name
ANTELOPE VALLEY COMMUNITY CLINIC
Practice address
502 Sugar Loaf Dr
Palmdale, CA 93551-7953
Phone
(661) 942-2391
NPI assigned
Sep 19, 2017
Organization subpart
No

Authorized official

Name
James Cook
Title
Administrator/Ceo
Phone
(661) 942-2391

Corporate family (same tax ID) 4

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Lancaster Adult Day Health Care (5 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Yes

Addresses

Primary practice location

502 Sugar Loaf Dr
Palmdale, CA 93551-7953

Mailing address

45104 10TH St W
Lancaster, CA 93534-2310
Phone (661) 942-2391

Other identifiers

IdentifierTypeStateIssuer
190045ANOtherCASTATE LICENCSE

Other names

  • Residential Detox & SUD Treatment Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 23, 2019.

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1154840320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45104 10TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935342310",
            "telephone_number": "661-942-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 SUGAR LOAF DR",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935517953",
            "telephone_number": "661-942-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-19",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "661-942-2391"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCSE",
            "identifier": "190045AN",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Residential Detox & SUD Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmdale, CA

All providers in Palmdale, CA · Substance Abuse Rehabilitation Facility in California

Sources for this page

Verify at the official NPI Registry.