Organization
ANTELOPE VALLEY COMMUNITY CLINIC
Active
Other names
Residential Detox & SUD Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES COOK (ADMINISTRATOR/CEO)
(661) 942-2391
Entity
Organization
Contact information
Practice address
502 SUGAR LOAF DR, PALMDALE, CA 93551-7953
(661) 942-2391
Mailing address
45104 10TH ST W, LANCASTER, CA 93534-2310
(661) 942-2391
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190045AN
STATE LICENCSE
CA
Enumeration date
09/19/2017
Last updated
05/23/2019
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