Healthcare Provider Details

I. General information

NPI: 1871299917
Provider Name (Legal Business Name): OXNARD REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S A ST FL 1
OXNARD CA
93030-7179
US

IV. Provider business mailing address

1800 VINE ST STE 216
LOS ANGELES CA
90028-5250
US

V. Phone/Fax

Practice location:
  • Phone: 310-343-8684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAINA DONNER
Title or Position: OWNER
Credential:
Phone: 310-343-8684