Healthcare Provider Details

I. General information

NPI: 1083958177
Provider Name (Legal Business Name): MALIBU BALANCE DAY TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 LAS VIRGENES RD SUITE 202
CALABASAS CA
91302-1956
US

IV. Provider business mailing address

4505 LAS VIRGENES RD SUITE 202
CALABASAS CA
91302-1956
US

V. Phone/Fax

Practice location:
  • Phone: 818-880-0800
  • Fax: 818-880-0808
Mailing address:
  • Phone: 818-880-0800
  • Fax: 818-880-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CUSACK
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 818-880-0800