Healthcare Provider Details

I. General information

NPI: 1457697831
Provider Name (Legal Business Name): BALANCE TREATMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N FIR STREET SUITE C
VENTURA CA
93001
US

IV. Provider business mailing address

121 N FIR STREET SUITE C
VENTURA CA
93001
US

V. Phone/Fax

Practice location:
  • Phone: 855-414-8100
  • Fax:
Mailing address:
  • Phone: 818-960-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CUSACK
Title or Position: COO
Credential:
Phone: 818-960-6830