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General NPI Number Information
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NPI Number | 1104443779
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Entity Type | Organization
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Legal Business Name | CMJ RECOVERY CA LLC
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 4960 VANALDEN AVE
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City | TARZANA
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State | CA
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Zip | 91356-4718
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Country | US
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Telephone | 412-874-8157
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Fax |
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Provider Business Mailing Address
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Address Line | 1777 AVENUE OF THE STATES STE 102
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City | LAKEWOOD
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State | NJ
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Zip | 08701-6205
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Country | US
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Telephone | 847-345-5541
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KYLEE BRINEY
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Credential |
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Telephone | 949-531-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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