Organization
AXIS RESIDENTIAL TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD T KEITH CCDC CAD CA (CEO)
(310) 435-6298
Entity
Organization
Contact information
Practice address
75450 FAIRWAY DR, INDIAN WELLS, CA 92210-8421
(760) 469-8275
(760) 346-8032
Mailing address
75450 FAIRWAY DR, INDIAN WELLS, CA 92210-8421
(760) 469-8275
(760) 346-8032
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
330082AP
CA
Other
Enumeration date
04/19/2007
Last updated
07/31/2008
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