MEDICARE: NULIFE MULHOLLAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	190805AP	CA

General Provider Information

NPI Number	:	1235673005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NULIFE MULHOLLAND LLC

Provider Business Mailing Address
First Line	:	4232 LAS VIRGENES RD STE B
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3589
Country	:	US
Telephone Number	:	888-508-1179
Fax Number	:

Provider Business Practice Location Address
First Line	:	4232 LAS VIRGENES RD STE B
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3589
Country	:	US
Telephone Number	:	888-508-1179
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN DAVID MEINTS JR.
Credential	:
Telephone Number	:	818-274-6376

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	12/13/2016

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