| Independence Community Treatment Clinic | |
|
39055 25th St W Room426,427,428,429,430 Palmdale CA 93551-4164 | |
| (818) 776-1755 | |
| (818) 776-1657 |
| Full Name | Independence Community Treatment Clinic |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 39055 25th St W, Palmdale, California |
| Authorized Official Name and Position | Alex Branzburg (PROGRAM DIRECTOR) |
| Authorized Official Contact | 8187761755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Community Treatment Clinic 19231 Victory Blvd Suite 554 Reseda CA 91335-6308 Ph: (818) 776-1755 | Independence Community Treatment Clinic 39055 25th St W Room426,427,428,429,430 Palmdale CA 93551-4164 Ph: (818) 776-1755 |
| NPI Number | 1205081593 |
|---|---|
| Provider Enumeration Date | 12/01/2008 |
| Last Update Date | 12/11/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205081593 | NPI | - | NPPES |
| CMM70956F | Medicaid | CA | |
| 196856000 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | 960001358 (California) | Primary |
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