Organization
STATE HEALTH CARE DUAL DIAGNOSIS
Active
Other names
State Health Care Dual Diagnosis
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EDNA MILLER (PRESIDENT)
(310) 628-9512
Entity
Organization
Contact information
Practice address
1145 W HEDGES AVE, FRESNO, CA 93728-1219
(310) 628-9512
(818) 804-4047
Mailing address
19300 RINALDI ST STE 8270, NORTHRIDGE, CA 91326-1651
(310) 628-9512
(818) 804-4047
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
100056AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1069
DMC PROVIDER NUMBER
CA
Enumeration date
05/23/2007
Last updated
08/22/2020
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