Healthcare Provider Details

I. General information

NPI: 1962399238
Provider Name (Legal Business Name): PSALM 23 RETREAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19765 RINALDI ST STE A
PORTER RANCH CA
91326-4245
US

IV. Provider business mailing address

19765 RINALDI ST STE A
PORTER RANCH CA
91326-4245
US

V. Phone/Fax

Practice location:
  • Phone: 818-521-1790
  • Fax:
Mailing address:
  • Phone: 818-521-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BUSTOS
Title or Position: CEO
Credential:
Phone: 818-521-1790