=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356042105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIMENSIONS RECOVERY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2023
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20944 SHERMAN WAY STE 115
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-554-5781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20944 SHERMAN WAY STE 115
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-226-1847
-----------------------------------------------------
Fax | 747-226-1865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR/CEO
-----------------------------------------------------
Name | MARILYNN MCKEEVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-554-5781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------