Independence Community Treatment Clinic
Clinic/Center, Community Health in Quartz Hill, CA. Organization (NPI-2).
NPI number1417192550
StatusActive
Last updated in NPPESDec 11, 2009
Details
- NPI
- 1417192550
- Entity type
- Organization (NPI-2)
- Legal business name
- Independence Community Treatment Clinic
- Organization subpart
- No
- Enumeration date
- Dec 3, 2008
- Last updated
- Dec 11, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QC1500X | Clinic/Center, Community Health | 960001358 | CA | Yes |
Practice location
6040 W Avenue LRoom423,v3, Agi
Quartz Hill, CA 93536-4501
Phone 818-776-1755 · Fax 818-776-1657
Mailing address
19231 Victory BlvdSuite 554
Reseda, CA 91335-6308
Phone 818-776-1755 · Fax 818-776-1657
Authorized official
Alex Branzburg
Program Director
8187761755
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