Healthcare Provider Details

I. General information

NPI: 1336708767
Provider Name (Legal Business Name): GOLDEN VENTURA CRT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

13347 VENTURA BLVD
SHERMAN OAKS CA
91423-4267
US

V. Phone/Fax

Practice location:
  • Phone: 805-233-7750
  • Fax:
Mailing address:
  • Phone: 818-385-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS JACOB UNGER
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 818-960-0295