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General NPI Number Information
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NPI Number | 1437310695
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Entity Type | Organization
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Legal Business Name | THE CANYON AT PEACE PARK, LLC
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 2900 S. KANAN DUME ROAD
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City | MALIBU
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State | CA
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Zip | 90265-2792
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Country | US
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Telephone | 310-457-3209
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Fax | 310-457-4440
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Provider Business Mailing Address
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Address Line | 210 WESTWOOD PLACE, SUITE 120
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City | BRENTWOOD
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State | TN
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Zip | 37027-7554
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Country | US
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Telephone | 615-342-3200
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. KATHLEEN BIGSBY
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Credential | PHD, MSW
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Telephone | 310-457-3209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190441BP
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License Number State | CA
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