Organization
STATE HEALTH CARE DUAL DIAGNOSIS PROGRAM
Active
Other names
State Health Care Dual Diagnosis Program
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, SUITE B, FRESNO, CA 93728-1219
(310) 628-9512
(818) 804-4047
Mailing address
19300 RINALDI ST, SUITE 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
100056BP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1068
DMC PROVIDER NUMBER
CA
Enumeration date
05/25/2007
Last updated
08/22/2020
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