Independence Community Treatment Clinic
Organization Active NPI Community Health Clinic/Center · Quartz Hill, CA
NPI 1417192550 · NPPES record last updated Dec 11, 2009
Key facts
- NPI
- 1417192550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- License
- 960001358 (CA)
- Legal business name
- INDEPENDENCE COMMUNITY TREATMENT CLINIC
- Practice address
- 6040 W Avenue L
Room423,V3, Agi
Quartz Hill, CA 93536-4501 - Phone
- (818) 776-1755
- Fax
- (818) 776-1657
- NPI assigned
- Dec 3, 2008
- Organization subpart
- No
Authorized official
- Name
- Alex Branzburg
- Title
- Program Director
- Phone
- (818) 776-1755
Corporate family (same tax ID) 17
National Provider Directory
- Tax ID family
- Independence Community Treatment Clinic
Locations
6040 W Avenue L
Rm 423V3
Quartz Hill, CA 93536
19231 Victory Blvd
Ste 554
Reseda, CA 91335
Phone (747) 300-0560
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 960001358 | CA | Yes |
Addresses
Primary practice location
6040 W Avenue L
Room423,V3, Agi
Quartz Hill, CA 93536-4501
Mailing address
19231 Victory Blvd
Suite 554
Reseda, CA 91335-6308
Phone (818) 776-1755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 196856000 | Medicaid | CA | |
| CMM70956F | Medicaid | CA |
Other providers in Quartz Hill, CA
- Emily Fernandez
- Johnnie Harrison
- Michelle C Harrison
- Glen Allen Horst
- Patricia Hull
- Donald Iwuagwu
- Cheridah Jones Lignier
- Yvonne Luk
- Monica Matte
- Stephan O'Bryant
All providers in Quartz Hill, CA · Community Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.