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General NPI Number Information
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NPI Number | 1053978874
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Entity Type | Organization
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Legal Business Name | MANIFEST SYLVAN OPERATION, LLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 22703 SYLVAN ST
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-1625
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Country | US
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Telephone | 818-963-9319
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Fax |
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Provider Business Mailing Address
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Address Line | 22647 VENTURA BLVD STE 446
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1416
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Country | US
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Telephone | 310-905-4424
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JULIE BARRON
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Credential |
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Telephone | 951-452-8536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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