Healthcare Provider Details

I. General information

NPI: 1316320047
Provider Name (Legal Business Name): RYLIST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 7TH ST SUITE B
SANTA MONICA CA
90401
US

IV. Provider business mailing address

1408 E THOUSAND OAKS BLVD
THOUSAND OAKS CA
91362-2889
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3873
  • Fax:
Mailing address:
  • Phone: 833-239-3552
  • Fax: 805-777-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number560038AP
License Number StateCA

VIII. Authorized Official

Name: JULIE LOVIER
Title or Position: BILLING MANAGER
Credential:
Phone: 805-852-1267