Healthcare Provider Details

I. General information

NPI: 1013348374
Provider Name (Legal Business Name): RYLIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 LA GRANADA DR
THOUSAND OAKS CA
91362-2143
US

IV. Provider business mailing address

3625 E THOUSAND OAKS BLVD SUITE102
WESTLAKE VILLAGE CA
91362-3626
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3873
  • Fax: 805-777-9226
Mailing address:
  • Phone: 805-777-3873
  • Fax: 805-777-3874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number550002229
License Number StateCA

VIII. Authorized Official

Name: MR. STEVE JOHN ZAMARIPPA
Title or Position: CEO
Credential:
Phone: 818-584-5615