Healthcare Provider Details

I. General information

NPI: 1831541986
Provider Name (Legal Business Name): TIKVA TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E GRANDE AVE
ARROYO GRANDE CA
93420
US

IV. Provider business mailing address

391 FRONT STREET SUITE F
GROVER BEACH CA
93433
US

V. Phone/Fax

Practice location:
  • Phone: 805-202-3440
  • Fax: 805-202-3441
Mailing address:
  • Phone: 805-202-3440
  • Fax: 805-202-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number400009BP
License Number StateCA

VIII. Authorized Official

Name: MR. ARI HIRT
Title or Position: OWNER/CEO
Credential: MBA
Phone: 805-202-3440