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General NPI Number Information
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NPI Number | 1205202926
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Entity Type | Organization
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Legal Business Name | ACADIA MALIBU, INC.
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 28955 PACIFIC COAST HWY STE 210
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City | MALIBU
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State | CA
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Zip | 90265-3930
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Country | US
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Telephone | 310-975-5344
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Fax |
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Provider Business Mailing Address
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Address Line | 30765 PACIFIC COAST HIGHWAY, #135
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City | MALIBU
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State | CA
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Zip | 90265
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Country | US
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Telephone | 310-975-5344
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | MR. EVAN HAINES
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Credential | M.A.
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Telephone | 310-975-5344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 190786BP
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License Number State | CA
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