=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437656295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESIGN FOR LIVING BEHAVIOR HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2018
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38700 5TH ST W STE E
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-3996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-800-4828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43858 BEECH AVE
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-800-4828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOSEPH HUNTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-497-8177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 190735CP
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------