NPIMap

Organization Active NPI

Antelope Valley Community Clinic

Doing business as Residential Detox & SUD Treatment

  • Substance Abuse Rehabilitation Facility
  • Palmdale, CA
National Provider Identifier
1154840320
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
ANTELOPE VALLEY COMMUNITY CLINIC
Doing business as
Residential Detox & SUD Treatment
Practice address
502 Sugar Loaf Dr
Palmdale, CA 93551-7953
Phone
(661) 942-2391
NPI assigned
Sep 19, 2017
Last updated
May 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Residential Detox & SUD Treatment Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Antelope Valley Community Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Residential Detox & SUD Treatment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmdale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.