Healthcare Provider Details

I. General information

NPI: 1497183503
Provider Name (Legal Business Name): PARADIGM TREATMENT CENTERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 VIA ESCONDIDO DR
MALIBU CA
90265-4484
US

IV. Provider business mailing address

6323 VIA ESCONDIDO DR
MALIBU CA
90265-4484
US

V. Phone/Fax

Practice location:
  • Phone: 310-457-6300
  • Fax: 310-457-6318
Mailing address:
  • Phone: 310-457-6300
  • Fax: 310-457-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. COLE RUCKER
Title or Position: CEO
Credential:
Phone: 310-710-4000