Healthcare Provider Details

I. General information

NPI: 1437039930
Provider Name (Legal Business Name): MK ADOLESCENT BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11044 MCBROOM ST
SUNLAND CA
91040-1267
US

IV. Provider business mailing address

11044 MCBROOM ST
SUNLAND CA
91040-1267
US

V. Phone/Fax

Practice location:
  • Phone: 424-486-1434
  • 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
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LUCA HAVIK
Title or Position: MANING MANAGER
Credential:
Phone: 310-498-3830