Provider Demographics
NPI:1902258908
Name:SO CAL TREATMENT OUTPATIENT
Entity Type:Organization
Organization Name:SO CAL TREATMENT OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-381-0432
Mailing Address - Street 1:546 S CITRON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4420
Mailing Address - Country:US
Mailing Address - Phone:714-381-0432
Mailing Address - Fax:714-333-4866
Practice Address - Street 1:2166 W BROADWAY
Practice Address - Street 2:#134
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2446
Practice Address - Country:US
Practice Address - Phone:714-381-0432
Practice Address - Fax:714-333-4866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOT DAYS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility