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General NPI Number Information
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NPI Number | 1114532660
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Entity Type | Organization
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Legal Business Name | MALIBU SEASIDE SERENITY COVE, INC.
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 6134 BUSCH DR
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City | MALIBU
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State | CA
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Zip | 90265-3833
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Country | US
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Telephone | 310-457-7919
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Fax |
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Provider Business Mailing Address
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Address Line | 6134 BUSCH DR
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City | MALIBU
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State | CA
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Zip | 90265-3833
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Country | US
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Telephone | 310-457-7919
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | FRANK SANTANGELO
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Credential |
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Telephone | 310-346-0088
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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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