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General NPI Number Information
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NPI Number | 1376159566
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Entity Type | Organization
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Legal Business Name | 3855 BRUNSTON LLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 5182 GARRETT CT
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City | HIDDEN HILLS
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State | CA
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Zip | 91302-1143
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Country | US
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Telephone | 888-643-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 28632 ROADSIDE DR STE 235
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City | AGOURA HILLS
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State | CA
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Zip | 91301-6095
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Country | US
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Telephone | 888-643-7135
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Fax |
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | KRISTA DENNIS
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Credential |
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Telephone | 805-579-3537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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