Provider Demographics
NPI:1306534797
Name:CORRECTIONAL HEALTH TREATMENT CENTERS INC
Entity type:Organization
Organization Name:CORRECTIONAL HEALTH TREATMENT CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:626-223-5071
Mailing Address - Street 1:473 S CARNEGIE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4201
Mailing Address - Country:US
Mailing Address - Phone:626-223-5071
Mailing Address - Fax:
Practice Address - Street 1:473 S CARNEGIE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4201
Practice Address - Country:US
Practice Address - Phone:626-223-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health