Healthcare Provider Details

I. General information

NPI: 1831021674
Provider Name (Legal Business Name): WHITE OAK RECOVERY CENTER OUTPATIENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6023 HAZELTINE AVE
VAN NUYS CA
91401-3525
US

IV. Provider business mailing address

4009 MASONBORO LOOP RD
WILMINGTON NC
28409-3640
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-9222
  • Fax: 910-408-0887
Mailing address:
  • Phone: 704-838-9222
  • Fax: 910-408-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEATON WEBER
Title or Position: CEO
Credential:
Phone: 704-838-9222