NPIMap

Organization Active NPI

Tarzana Treatment Centers, Inc.

  • Multi-Specialty Clinic/Center
  • Northridge, CA
National Provider Identifier
1427043389
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
TARZANA TREATMENT CENTERS, INC.
Practice address
8330 Reseda Blvd
Northridge, CA 91324-4619
Phone
(818) 654-3911
Fax
(818) 996-3051
NPI assigned
Sep 16, 2005
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Jim Sorg
Title
Director of Information Technology
Phone
(818) 654-3911

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Multi-Specialty Clinic/Center 261QM1300X Primary
Clinic Pharmacy 3336C0002X

Addresses

Primary practice location

8330 Reseda Blvd
Northridge, CA 91324-4619

Mailing address

18646 Oxnard St
Tarzana, CA 91356-1411
Phone (818) 654-3911

Other identifiers 2

IdentifierTypeStateIssuer
CMM70738FMedicaidCA
CMM70739FMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070822001488 CA Part B Supplier - Clinic/Group Practice 5991897845 Receives reassigned benefits from 100 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tarzana, CA; Woodland Hills, CA; Reseda, CA; Palmdale, CA; Los Angeles, CA; Northridge, CA; Lancaster, CA; Long Beach, CA
O20210202000821 CA Part A Provider - Federally Qualified Health Center (FQHC) 5991897845 Practice locations: Northridge, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427043389. Details of each certification follow.

Federally qualified health center certification: CCN 921921

Legal name
TARZANA TREATMENT CENTERS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 25, 2021
Last certification
Jan 25, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1972 in CA
Enrollment address
8330 Reseda Blvd
Northridge, CA 91324-4619

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

National Provider Directory

National Provider Directory

Locations

44447 10th St W
Lancaster, CA 93534
Phone 6617262630 ext. 4133

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kenneth Bachrach Individual Corporate DirectorClinical Director Jun 10, 1987
Antionette Olivarez Individual Corporate DirectorDirector of Nursing Nov 21, 2016
Keith Ian Star Individual Corporate DirectorDirector of Inpatient-Detox Jan 31, 2005
Stanley Galperson Individual Corporate DirectorDirector of Residential Jan 8, 1996
Alesia Ping-Difiore Individual Corporate DirectorDirector of Antelope Valley Sep 1, 2006
Jim Sorg Individual Corporate DirectorDirector of Integrated Care Aug 1, 2000
Michael Sheptenko Individual Corporate DirectorBoard Treasurer Jul 1, 2009
Nora Monica Kirshberg Individual Corporate DirectorBoard Member Jul 1, 2019
Ronald Kurstin Individual Corporate DirectorBoard Member Jul 1, 2002
Anne Greenberg Individual Corporate DirectorBoard Member Jul 1, 2009
Silvia Cadena Individual Corporate OfficerChief Financial Officer Aug 1, 1988
Albert Senella Individual Corporate OfficerPresident/Chief Executive Officer Aug 1, 1998 100%
Operational/Managerial ControlPresident/Chief Executive Officer Aug 1, 1998 100%
Rudolph Omurray Individual Corporate DirectorDirector of Primary Care Mar 1, 2017
Tarzana Treatment Centers Inc Organization, Tarzana, CA Non-profit Operational/Managerial Control Aug 1, 1998 100%
Lauren Dibbs Individual Corporate DirectorDirector of Long Beach Apr 25, 2008
Jose Salazar Individual Corporate DirectorDirector of Program Development Oct 31, 2001
Andrew Kirshberg Individual Corporate DirectorBoard Member Jul 1, 1989
VA Lecia Adams Individual Corporate DirectorBoard Member Jul 1, 2017
Gina Trinidad Individual Corporate DirectorDirector of Human Resources May 15, 2002
Richard Helfman Individual Corporate DirectorBoard Chairperson Jul 1, 2005
Patrick Ogawa Individual Corporate DirectorBoard Member Jul 1, 2010
Linda Farris-Vogel Individual Corporate DirectorBoard Member Jul 1, 2017

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tarzana Treatment Centers IncTarzana, CA, CCN 054148 Hospital Operational/Managerial Control (100%) Aug 15, 1972
Tarzana Treatment Centers IncLancaster, CA, CCN 921920 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998
Tarzana Treatment Centers IncTarzana, CA, CCN 921948 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998
Tarzana Treatment Centers IncPalmdale, CA, CCN 921922 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998
Tarzana Treatment Centers IncReseda, CA, CCN 921947 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998
Tarzana Treatment Centers IncLong Beach, CA, CCN A01020 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998
Tarzana Treatment Centers IncReseda, CA, CCN A11012 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998
Tarzana Treatment Centers IncPalmdale, CA, CCN A01971 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 1998

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1427043389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18646 OXNARD ST",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913561411",
            "telephone_number": "818-654-3911",
            "fax_number": "818-996-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8330 RESEDA BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913244619",
            "telephone_number": "818-654-3911",
            "fax_number": "818-996-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARZANA TREATMENT CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "SORG",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "DIRECTOR OF INFORMATION TECHNOLOGY",
        "authorized_official_telephone_number": "818-654-3911"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70738F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70739F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.