Healthcare Provider Details

I. General information

NPI: 1093156879
Provider Name (Legal Business Name): CAST RECOVERY SERVICES OF SANTA MONICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 WILSHIRE BLVD SUITE 105
SANTA MONICA CA
90401-1421
US

IV. Provider business mailing address

530 WILSHIRE BLVD SUITE 105
SANTA MONICA CA
90401-1421
US

V. Phone/Fax

Practice location:
  • Phone: 310-873-3935
  • Fax: 310-564-1883
Mailing address:
  • Phone: 310-873-3935
  • Fax: 310-564-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL GARDINER BAYER
Title or Position: CEO
Credential: CADC II, BRI II
Phone: 310-873-3935