Organization
TAVARUA MEDICAL REHABILITATION SERVICES
Active
Other names
AZUSA MEDICAL AND MENTAL HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA ANN BLANKS (EXECUTIVE DIRECTOR)
(661) 254-6630
Entity
Organization
Contact information
Practice address
474 S CITRUS AVE, AZUSA, CA 91702-4733
(626) 858-9500
(626) 858-9090
Mailing address
26460 SUMMIT CIR, SANTA CLARITA, CA 91350-2991
(661) 254-6630
(661) 254-6644
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
19-126
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-126
STATE NTP LICENSE
CA
05
—
19CQ
—
CA
Enumeration date
03/27/2012
Last updated
10/31/2025
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