Provider Demographics
NPI:1730630591
Name:TARZANA TREATMENT CENTER
Entity type:Organization
Organization Name:TARZANA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:LORRAINE RAGOSTA LMF
Authorized Official - Phone:818-543-1820
Mailing Address - Street 1:13535 VALERIO ST APT 258
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2723
Mailing Address - Country:US
Mailing Address - Phone:818-618-6097
Mailing Address - Fax:
Practice Address - Street 1:8330 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4619
Practice Address - Country:US
Practice Address - Phone:818-996-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty