NPIMap

Organization Active NPI

Independence Community Treatment Clinic

  • Community Health Clinic/Center
  • Reseda, CA
National Provider Identifier
1376677823
Registry record updated Jan 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
960001358 Issued in CA
Legal business name
INDEPENDENCE COMMUNITY TREATMENT CLINIC
Practice address
19231 Victory Blvd
Suite 554
Reseda, CA 91335-6308
Phone
(818) 776-1755
Fax
(818) 776-1657
NPI assigned
Mar 15, 2007
Last updated
Jan 6, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2010

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

Authorized official

Name
Rebecca Greenough, CATCNPI 1720238678
Title
Asst. Program Director
Phone
(818) 776-1755

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 960001358 CA Primary

Addresses

Primary practice location

19231 Victory Blvd
Suite 554
Reseda, CA 91335-6308

Mailing address

19231 Victory Blvd
Suite 554
Reseda, CA 91335-6308
Phone (818) 776-1755

Other identifiers 2

IdentifierTypeStateIssuer
196856000MedicaidCA
CMM70956FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Independence Community Treatment Clinic18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262736000000",
    "number": "1376677823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19231 VICTORY BLVD",
            "address_2": "SUITE 554",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356308",
            "telephone_number": "818-776-1755",
            "fax_number": "818-776-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19231 VICTORY BLVD",
            "address_2": "SUITE 554",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356308",
            "telephone_number": "818-776-1755",
            "fax_number": "818-776-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE COMMUNITY TREATMENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2010-01-06",
        "status": "A",
        "authorized_official_last_name": "GREENOUGH",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "ASST. PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "818-776-1755",
        "authorized_official_credential": "CATC"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "960001358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196856000",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70956F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; 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.