# INDEPENDENCE COMMUNITY TREATMENT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508039728
- **Authorized official:** ALEX BRANZBURG (PROGRAM DIRECTOR)
- **Authorized official phone:** (818) 776-1755

## Contact information

- **Practice address:** 209 W AVENUE J, ROOMS E,G, H, FRONT OFFICE, LANCASTER, CA 93534-3656
- **Practice address phone:** (818) 776-1755
- **Practice address fax:** (818) 776-1657
- **Mailing address:** 19231 VICTORY BLVD, SUITE 554, RESEDA, CA 91335-6308
- **Mailing address phone:** (818) 776-1755
- **Mailing address fax:** (818) 776-1657

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 960001358 | CA | Yes |

## Other

- **Enumeration date:** 04/09/2008
- **Last updated:** 07/01/2010