Healthcare Provider Details

I. General information

NPI: 1487376315
Provider Name (Legal Business Name): BALANCE TREATMENT SLO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LOWER RAGSDALE DRIVE, SUITE 120
MONTEREY CA
93940
US

IV. Provider business mailing address

4505 LAS VIRGENES RD. STE. 201
CALABASAS CA
91302
US

V. Phone/Fax

Practice location:
  • Phone: 855-414-8100
  • Fax:
Mailing address:
  • Phone: 323-646-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CUSACK
Title or Position: CFO
Credential:
Phone: 323-646-9271