Healthcare Provider Details

I. General information

NPI: 1831533918
Provider Name (Legal Business Name): RYLIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 KALINDA PL
THOUSAND OAKS CA
91320-2739
US

IV. Provider business mailing address

275 E HILLCREST DR SUITE 120
THOUSAND OAKS CA
91360-5827
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3873
  • Fax: 805-777-3874
Mailing address:
  • Phone: 800-560-8518
  • Fax: 805-777-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number550002229
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE ZAMARIPPA
Title or Position: CEO
Credential: CEO
Phone: 805-777-3873