Provider Demographics
NPI:1396318325
Name:CDT SERVICE CORPORATION
Entity type:Organization
Organization Name:CDT SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:916-784-1149
Mailing Address - Street 1:11230 GOLD EXPRESS DR # 310-353
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4484
Mailing Address - Country:US
Mailing Address - Phone:916-784-1149
Mailing Address - Fax:
Practice Address - Street 1:15140 SYLVESTER RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6826
Practice Address - Country:US
Practice Address - Phone:916-847-4006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility