Dual Diagnosis Treatment Center, Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

300217AN Issued in CA

Legal business name

DUAL DIAGNOSIS TREATMENT CENTER, INC.

Practice address

69508 Borrego Rd
Cathedral City, CA 92234-4923

Phone

(949) 359-8273

Fax

(949) 943-1541

NPI assigned

Feb 9, 2009

Organization subpart

No

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

Authorized official

Name

Ron Girskis

Title

Business Operations Specialist

Phone

(949) 359-8273

Specialties & licenses 1

Addresses

Other names 1

• Sovereign Health of California Doing business as

Tax ID family

Dual Diagnosis Treatment Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Dual Diagnosis Treatment Center, Inc.

  • Substance Abuse Rehabilitation Facility
  • San Clemente, CA
  • NPI 1124394549
  NPD tax ID

Locations

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

{
    "created_epoch": "1234137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1407095912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5705",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926745705",
            "telephone_number": "949-625-0376",
            "fax_number": "949-390-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69508 BORREGO RD",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922344923",
            "telephone_number": "949-359-8273",
            "fax_number": "949-943-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUAL DIAGNOSIS TREATMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-09",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A",
        "authorized_official_last_name": "GIRSKIS",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS SPECIALIST",
        "authorized_official_telephone_number": "949-359-8273"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300217AN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sovereign Health of California",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sovereign Health of California",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Esther Domenech, MPT
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• Dr Ramsey Katan, O.D.
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• Diane E. Ducatte
• Joseph Wayne Dunn, PH.D.
• Jasmine Viviana Duran, PPS
• Thomas Kenneth Ebersten, LCSW
• Elliott Edes, MD

• Substance Abuse Rehabilitation Facility in Cathedral City, CA
• Providers in Cathedral City, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.