Healthcare Provider Details

I. General information

NPI: 1063291805
Provider Name (Legal Business Name): RYLIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LMU DRIVE MALONE BLDG STE 401
LOS ANGELES CA
90045
US

IV. Provider business mailing address

1408 E THOUSAND OAKS BLVD
THOUSAND OAKS CA
91362-2889
US

V. Phone/Fax

Practice location:
  • Phone: 800-560-8518
  • Fax: 805-777-9226
Mailing address:
  • Phone: 800-560-8518
  • Fax: 805-777-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JULIE LOVIER
Title or Position: BILLING MANAGER
Credential:
Phone: 805-657-7222