Healthcare Provider Details

I. General information

NPI: 1124938147
Provider Name (Legal Business Name): BRIGHT LIFE DETOX & RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3164 ELMORE ST
SIMI VALLEY CA
93063-2620
US

IV. Provider business mailing address

3164 ELMORE ST
SIMI VALLEY CA
93063-2620
US

V. Phone/Fax

Practice location:
  • Phone: 805-261-0339
  • Fax: 805-261-0130
Mailing address:
  • Phone: 805-261-0339
  • Fax: 805-261-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KARINE MATNISHYAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN, BSN
Phone: 818-392-0554