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General NPI Number Information
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NPI Number | 1689167553
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Entity Type | Organization
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Legal Business Name | WESTLAKE REVIVE
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 227 W JANSS RD STE 350
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City | THOUSAND OAKS
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State | CA
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Zip | 91360
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Country | US
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Telephone | 805-286-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 S WESTLAKE BLVD # 14-289
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-3108
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Country | US
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Telephone | 805-286-1180
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JESSICA ANDERSON
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Credential |
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Telephone | 805-286-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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