Healthcare Provider Details

I. General information

NPI: 1417623505
Provider Name (Legal Business Name): RYLIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 RANCHO RD
THOUSAND OAKS CA
91362-2635
US

IV. Provider business mailing address

155 E WILBUR RD
THOUSAND OAKS CA
91360-7935
US

V. Phone/Fax

Practice location:
  • Phone: 800-560-8518
  • Fax: 805-777-9226
Mailing address:
  • Phone: 805-657-7222
  • Fax: 805-777-9226

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: JULIE LOVIER
Title or Position: BILLING MANAGER
Credential:
Phone: 805-657-7222