Healthcare Provider Details

I. General information

NPI: 1124496039
Provider Name (Legal Business Name): RESILIENCE TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD STE 400
LOS ANGELES CA
90025-7616
US

IV. Provider business mailing address

PO BOX 45974
SAN FRANCISCO CA
94145-0974
US

V. Phone/Fax

Practice location:
  • Phone: 310-963-2065
  • Fax:
Mailing address:
  • Phone: 314-740-0786
  • Fax: 818-963-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHELSEY SORENSEN
Title or Position: VP RCM AND UR
Credential:
Phone: 314-740-0786