Healthcare Provider Details

I. General information

NPI: 1720628548
Provider Name (Legal Business Name): FOR THE FUTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 ALTA ST
SIMI VALLEY CA
93063-2452
US

IV. Provider business mailing address

9800 TOPANGA CANYON BLVD STE D-309
CHATSWORTH CA
91311-4076
US

V. Phone/Fax

Practice location:
  • Phone: 805-791-3725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MARAL PUSHIAN SULTANIAN
Title or Position: HEAD OF SERVICE
Credential: LMFT
Phone: 805-296-8677