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General NPI Number Information
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NPI Number | 1437039930
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Entity Type | Organization
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Legal Business Name | MK ADOLESCENT BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 11044 MCBROOM ST
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City | SUNLAND
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State | CA
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Zip | 91040-1267
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Country | US
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Telephone | 424-486-1434
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Fax |
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Provider Business Mailing Address
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Address Line | 11044 MCBROOM ST
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City | SUNLAND
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State | CA
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Zip | 91040-1267
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANING MANAGER
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Name | LUCA HAVIK
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Credential |
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Telephone | 310-498-3830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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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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