Organization
FAMILY DUAL DIAGNOSIS TREATMENT PROGRAMS
Active
Other names
Health Care Dual Diagnosis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDNA MILLER (PRESIDENT)
(310) 628-9512
Entity
Organization
Contact information
Practice address
285 HOSPITAL DR, CHOWCHILLA, CA 93610-2041
(310) 628-9512
(818) 804-4047
Mailing address
5529 N CLEO AVE, FRESNO, CA 93722-7713
(310) 628-9512
(818) 804-4047
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
200004AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012
DMC PROVIDER NUMBER
CA
Enumeration date
05/22/2007
Last updated
08/22/2020
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