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General NPI Number Information
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NPI Number | 1497120133
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Entity Type | Organization
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Legal Business Name | JAMES & BENTZ
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 31450 BROAD BEACH RD
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City | MALIBU
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State | CA
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Zip | 90265-2669
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Country | US
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Telephone | 424-644-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 30423 CANWOOD ST STE 227
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City | AGOURA
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State | CA
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Zip | 91301-4367
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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 | OWNER
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Name | MR. CHARLES BENTZ
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Credential | CPA
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Telephone | 310-595-4905
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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 | 190773AP
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License Number State | CA
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