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General NPI Number Information
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NPI Number | 1619460912
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Entity Type | Organization
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Legal Business Name | REWARD PATH RECOVERY LLC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 525 E. MAIN ST
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City | SANTA PAULA
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State | CA
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Zip | 93060
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Country | US
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Telephone | 805-216-2447
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Fax |
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Provider Business Mailing Address
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Address Line | 266 ROOSEVELT AVE
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City | VENTURA
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State | CA
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Zip | 93003-2581
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Country | US
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Telephone | 805-216-2447
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL ROLAND VIVIAN
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Credential | MD
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Telephone | 805-216-2447
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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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