Provider Demographics
NPI:1396803896
Name:ABTTC, INC.
Entity type:Organization
Organization Name:ABTTC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERROD
Authorized Official - Middle Name:N
Authorized Official - Last Name:MENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-517-4849
Mailing Address - Street 1:PO BOX 893507
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-3507
Mailing Address - Country:US
Mailing Address - Phone:800-990-0340
Mailing Address - Fax:954-208-5770
Practice Address - Street 1:41640 CORNING PL
Practice Address - Street 2:STE 104
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-7048
Practice Address - Country:US
Practice Address - Phone:800-517-4849
Practice Address - Fax:800-401-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330071AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330071BPOtherCA CERTIFICATION
CA330071APOtherCA LICENSE