ANTELOPE VALLEY COMMUNITY CLINIC (NPI# 1154840320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154840320 |
| Entity Type | Organization |
| Organization Name | ANTELOPE VALLEY COMMUNITY CLINIC |
| Other Organization Name | RESIDENTIAL DETOX & SUD TREATMENT |
| Practice Address |
502 Sugar Loaf Dr Palmdale CA 93551-7953 |
| Mailing Address |
45104 10th St W Lancaster CA 93534-2310 |
| Practice Telephone | 6619422391 |
| Mailing Telephone | 6619422391 |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2019-05-23 |
| Authorized Official Name | JAMES COOK (ADMINISTRATOR/CEO) |
| Authorized Official Telephone | 6619422391 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | STATE LICENCSE | 190045AN | 01 |
| Other Name | Type Code |
|---|---|
| Residential Detox & SUD Treatment | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730630427 | Antelope Valley Community Clinic | Clinic/Center | 45124 10th St W, Lancaster, CA 93534-2310 | 2016-10-18 |
| 1811448293 | Antelope Valley Community Clinic | Clinic/Center | 45124 10th St W, Lancaster, CA 93534-2310 | 2016-10-20 |
| 1720537863 | Antelope Valley Community Clinic | Clinic/Center | 37926 47th St E, Palmdale, CA 93552-3272 | 2016-09-30 |
| 1245690387 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2016-03-02 |
| 1730499872 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2010-10-07 |
| 1619290624 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2010-03-04 |
| 1346563673 | Antelope Valley Community Clinic | Clinic/Center | 2151 E Palmdale Blvd, Palmdale, CA 93550-4037 | 2010-03-01 |
| 1609199934 | Antelope Valley Community Clinic | Clinic/Center | 44216 10th St W, Lancaster, CA 93534-4134 | 2010-03-01 |
| 1710199674 | Antelope Valley Community Clinic | Clinic/Center | 45104 10th St W, Lancaster, CA 93534-2310 | 2007-05-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | ANTELOPE VALLEY COMMUNITY CLINIC | 45104 10th St W, Lancaster, CA 93534-2310 |
| Street Address |
502 SUGAR LOAF DR |
| City | PALMDALE |
| State | CA |
| Zip Code | 93551-7953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902445331 | Freedom Addiction Therapeutic Services,inc. | Substance Abuse Rehabilitation Facility | 502 Sugar Loaf Dr, Palmdale, CA 93551-7953 | 2020-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518578251 | Epak LLC | Registered Nurse | 6327 Giovanni Way, Palmdale, CA 93551 | 2020-08-16 |
| 1710500483 | Hmg Community Clinic Inc | Family Medicine | 38900 Trade Center Drive Suite B, Palmdale, CA 93551 | 2020-05-28 |
| 1891338372 | Babak Yousefi & Fariborz Rodef Dental Corporation | Dentist | 623 West Ave Q Suite #b, Palmdale, CA 93551 | 2019-10-28 |
| 1770052748 | The Kibbutz - Nature Serenity Renewal | Clinic/Center | 13136 Elizabeth Lake Rd, Leona Valley, CA 93551 | 2018-11-19 |
| 1306321872 | Vicky Elena Ledesma | Case Manager/Care Coordinator | 251 Grand Cypress Ave, Palmdale, CA 93551 | 2018-10-01 |
| 1972025898 | Tamika Estrella | Driver | 39553 Hawthorne St, Palmdale, CA 93551 | 2017-07-12 |
| 1245750751 | Tamara Vwich Dds Inc | Dentist | 3011 Rancho Vista Blvd., Suite I, Palmdale, CA 93551 | 2017-06-26 |
| 1487003356 | Thriving Consultingname | Home Health | 2845 Ladyfern Lane, Palmdale, CA 93551 | 2016-06-10 |
| 1235501750 | Jessica Andrea Ulloa | Counselor | 734 Celtic Dr, Palmdale, CA 93551 | 2015-10-23 |
| 1508240243 | Rachel Williams | Registered Nurse | 3961 Woburn Ct, Palmdale, CA 93551 | 2015-07-13 |
| Find all providers in zip 93551 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437656295 | Design for Living Behavior Health, Inc. | Substance Abuse Rehabilitation Facility | 38700 5th St W Ste E, Palmdale, CA 93551-3996 | 2018-04-09 |
| 1205331055 | Design for Living Behavior Health, Inc. | Substance Abuse Rehabilitation Facility | 39860 27th St W, Palmdale, CA 93551-3414 | 2018-03-26 |
| 1033643184 | Design for Living Behavior Health, Inc. | Substance Abuse Rehabilitation Facility | 36451 El Camino Dr, Palmdale, CA 93551-7915 | 2017-04-16 |
| 1326572512 | Design for Change | Substance Abuse Rehabilitation Facility | 40516 Milan Dr, Palmdale, CA 93551-2536 | 2017-04-14 |
| 1104045293 | William H. Davis Treatment Center | Substance Abuse Rehabilitation Facility | 1607 E Palmdale Blvd Ste G, Palmdale, CA 93550-7801 | 2007-04-25 |
| 1902445331 | Freedom Addiction Therapeutic Services,inc. | Substance Abuse Rehabilitation Facility | 502 Sugar Loaf Dr, Palmdale, CA 93551-7953 | 2020-01-02 |
| 1518174499 | Freyhardt & Lowe, Inc | Substance Abuse Rehabilitation Facility | 1607 E Palmdale Blvd, Suite G, Palmdale, CA 93550-4883 | 2007-05-17 |
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| 1376140384 | Magic House Recovery Inc | Substance Abuse Rehabilitation Facility | 1001 S Mountvale Ct, Anaheim, CA 92808-2108 | 2020-10-02 |
| 1942807060 | New Perceptions North, LLC | Substance Abuse Rehabilitation Facility | 5084 N Fruit Ave Ste 105, Fresno, CA 93711-3000 | 2020-10-01 |
| 1346857679 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 3480 Hidden Trail Dr, Jamul, CA 91935-2104 | 2020-09-30 |
| 1992312227 | Apex Recovery, LLC | Substance Abuse Rehabilitation Facility | 2810 Camino Del Rio S Ste 106, San Diego, CA 92108-3819 | 2020-09-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.