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General NPI Number Information
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NPI Number | 1568736403
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Entity Type | Organization
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Legal Business Name | THE TIDES SANTA BARBARA LLC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 5277 AUSTIN RD
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City | SANTA BARBARA
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State | CA
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Zip | 93111-2905
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Country | US
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Telephone | 805-636-6335
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Fax |
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Provider Business Mailing Address
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Address Line | 5277 AUSTIN RD
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City | SANTA BARBARA
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State | CA
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Zip | 93111-2905
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Country | US
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Telephone | 805-636-6335
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JAMES DALTON GERLACH
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Credential |
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Telephone | 805-636-6335
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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 | 420035AP
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License Number State | CA
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