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Organization

ANTELOPE VALLEY REHABILITATION CENTERS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREG HASELTINE (INTERIM EXECUTIVE DIRECTOR)
(661) 269-0074
Entity
Organization

Contact information

Practice address
44900 60TH ST W, CHP TRAILER, LANCASTER, CA 93536-7618
(661) 945-8458
(661) 945-8248
Mailing address
PO BOX 25, ACTON, CA 93510-0025
(661) 269-0062
(661) 269-0427

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6767
MEDI-CAL
CA
Enumeration date
04/20/2007
Last updated
08/22/2020
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