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General NPI Number Information
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NPI Number | 1457630741
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Entity Type | Organization
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Legal Business Name | OCEANSIDE TRANSITIONAL LIVING IN MALIBU
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 21022 PACIFIC COAST HWY
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City | MALIBU
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State | CA
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Zip | 90265-5242
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Country | US
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Telephone | 310-456-3355
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Fax | 310-456-3305
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Provider Business Mailing Address
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Address Line | 21022 PACIFIC COAST HWY
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City | MALIBU
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State | CA
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Zip | 90265-5242
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Country | US
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Telephone | 310-456-3355
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Fax | 310-456-3305
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID JOHNSON
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Credential |
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Telephone | 818-917-7239
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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 |
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License Number State |
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