Healthcare Provider Details

I. General information

NPI: 1639887326
Provider Name (Legal Business Name): CHANNEL ISLANDS REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4474 MARKET ST STE 505
VENTURA CA
93003-5812
US

IV. Provider business mailing address

4744 TELEPHONE RD STE 3
VENTURA CA
93003-5258
US

V. Phone/Fax

Practice location:
  • Phone: 805-218-0079
  • Fax: 805-834-0288
Mailing address:
  • Phone: 214-934-8999
  • Fax: 805-834-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLISON HOPKINS
Title or Position: CEO
Credential: PH.D.
Phone: 214-934-8999