Independence Community Treatment Clinic

LBN: Independence Community Treatment Clinic
Independence Community Treatment Clinic is an health care organization with primary practice located at 39055 25Th St W Room426,427,428,429,430, Palmdale CA 93551-4164. The organization recently has only one registered license in Ambulatory Health Care Facilities / Community Health, which is considered as the primary health care specialty. Independence Community Treatment Clinic can be contacted via phone (818) 776-1755, or through Branzburg, Alex via phone (818) 776-1755.

Contact Information

Primary practice address
39055 25Th St W Room426,427,428,429,430 Palmdale CA 93551-4164
Phone: (818) 776-1755
Fax: (818) 776-1657
Website:
Map and Directions
Authorized official contact:
Name: Branzburg, Alex
Phone: (818) 776-1755

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Community Health 261QC1500X 960001358 California

Profile Details

NPI number 1205081593
LBN Legal business name Independence Community Treatment Clinic
DBA Doing business as
Authorized official Branzburg, Alex
Entity Organization
Organization subpart 1 No
Enumeration date Dec 1st, 2008
Last updated Dec 11th, 2009 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205081593 NPPES
California MEDICAID CMM70956F
California MEDICAID 196856000

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