=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255882999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURAL REST HOUSE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2016
-----------------------------------------------------
Last Update Date | 11/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79100 OCOTILLO DR
-----------------------------------------------------
City | LA QUINTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92253-5915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-343-8684
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 VINE ST # 251
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90028-5250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-343-8684
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | NATHAN YOUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-343-8684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------