Healthcare Provider Details

I. General information

NPI: 1174289342
Provider Name (Legal Business Name): STILLWATER BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 NAVY ST
SANTA MONICA CA
90405-5946
US

IV. Provider business mailing address

19528 VENTURA BLVD # 383
TARZANA CA
91356-2917
US

V. Phone/Fax

Practice location:
  • Phone: 503-791-3205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS MATHEWS
Title or Position: CEO
Credential:
Phone: 503-791-3205