NPIMap

Organization Active NPI

Independence Community Treatment Clinic

  • Community Health Clinic/Center
  • Lancaster, CA
National Provider Identifier
1508039728
Registry record updated Jul 1, 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
209 W Avenue J
Rooms E,G, H, Front Office
Lancaster, CA 93534-3656
Phone
(818) 776-1755
Fax
(818) 776-1657
NPI assigned
Apr 9, 2008
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Alex Branzburg
Title
Program Director
Phone
(818) 776-1755

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

Locations

209 W Avenue J
Rm Eg
Lancaster, CA 93534

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

209 W Avenue J
Rooms E,G, H, Front Office
Lancaster, CA 93534-3656

Mailing address

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

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
CMM70956FMedicaidCA
196856000MedicaidCA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 1, 2010.

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277942400000",
    "number": "1508039728",
    "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": "209 W AVENUE J",
            "address_2": "ROOMS E,G, H, FRONT OFFICE",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343656",
            "telephone_number": "818-776-1755",
            "fax_number": "818-776-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE COMMUNITY TREATMENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-09",
        "last_updated": "2010-07-01",
        "status": "A",
        "authorized_official_last_name": "BRANZBURG",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "818-776-1755"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "960001358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70956F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196856000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.