Organization
TARZANA TREATMENT CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM SORG (DIRECTOR OF INFORMATION TECHNOLOGY)
(818) 654-3911
Entity
Organization
Contact information
Practice address
8330 RESEDA BLVD, NORTHRIDGE, CA 91324-4619
(818) 654-3911
(818) 996-3051
Mailing address
18646 OXNARD ST, TARZANA, CA 91356-1411
(818) 654-3911
(818) 996-3051
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM70738F
—
CA
05
—
CMM70739F
—
CA
Enumeration date
09/16/2005
Last updated
12/22/2020
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