Healthcare Provider Details

I. General information

NPI: 1063756849
Provider Name (Legal Business Name): RYLIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 N CONEJO SCHOOL RD
THOUSAND OAKS CA
91362
US

IV. Provider business mailing address

155 E WILBUR RD
THOUSAND OAKS CA
91360-7935
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number560038CP
License Number StateCA

VIII. Authorized Official

Name: MR. STEVE ZAMARRIPA
Title or Position: OWNER PRESIDENT
Credential: CEO
Phone: 818-584-5615