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General NPI Number Information
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NPI Number | 1609271394
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Entity Type | Organization
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Legal Business Name | RANCH MALIBU VENTURE 1
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 327 LATIGO CANYON RD
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City | MALIBU
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State | CA
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Zip | 90265-2708
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Country | US
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Telephone | 818-879-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 327 S. LATIGO CYN ROAD
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City | MALIBU
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State | CA
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Zip | 90265
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Country | US
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Telephone | 818-879-9110
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CAROLYN HAMILTON
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Credential |
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Telephone | 818-667-6550
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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 | 190649AP
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License Number State | CA
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