NPIMap

Organization Active NPI

Independence Community Treatment Clinic

  • Community Health Clinic/Center
  • Palmdale, CA
National Provider Identifier
1710122866
Registry record updated Dec 11, 2009
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
38801 Clock Tower Plaza Dr E
Room Community Building,104,105,106,107
Palmdale, CA 93550-3346
Phone
(818) 776-1755
Fax
(818) 776-1657
NPI assigned
Dec 3, 2008
Last updated
Dec 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2009

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

Authorized official

Name
Alex Brnzburg
Title
Program Director
Phone
(818) 776-1755

Specialties & licenses 1

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

Addresses

Primary practice location

38801 Clock Tower Plaza Dr E
Room Community Building,104,105,106,107
Palmdale, CA 93550-3346

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

Locations

38801 Clock Tower Plaza Dr E
Bldg 104105106107
Palmdale, CA 93550

NPI Registry JSON

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260489600000",
    "number": "1710122866",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38801 CLOCK TOWER PLAZA DR E",
            "address_2": "ROOM COMMUNITY BUILDING,104,105,106,107",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935503346",
            "telephone_number": "818-776-1755",
            "fax_number": "818-776-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE COMMUNITY TREATMENT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2009-12-11",
        "status": "A",
        "authorized_official_last_name": "BRNZBURG",
        "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": "196856000",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70956F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmdale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; 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.