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Organization
INDEPENDENCE COMMUNITY TREATMENT CLINIC
Active
Organization
INDEPENDENCE COMMUNITY TREATMENT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX BRANZBURG (EXECUTIVE PROGRAM DIRECTOR)
(818) 776-1755
Entity
Organization
Contact information
Practice address
43520 DIVISION ST, 202, CONFERENCE ROOM, LANCASTER, CA 93535-4089
(818) 776-1755
Mailing address
19231 VICTORY BLVD, RESEDA, CA 91335-6308
(818) 776-1755
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
960001358
CA
Other
Enumeration date
06/29/2009
Last updated
03/08/2010
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