Provider Demographics
NPI:1851645006
Name:NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE OF THE SAN FERNANDO V
Entity type:Organization
Organization Name:NATIONAL COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE OF THE SAN FERNANDO V
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:DORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:818-216-4183
Mailing Address - Street 1:24460 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2347
Mailing Address - Country:US
Mailing Address - Phone:661-253-9400
Mailing Address - Fax:661-253-9403
Practice Address - Street 1:24460 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2347
Practice Address - Country:US
Practice Address - Phone:661-253-9400
Practice Address - Fax:661-253-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health