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General NPI Number Information
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NPI Number | 1710693403
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Entity Type | Organization
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Legal Business Name | CLIFFSIDE MALIBU 1
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 5480 HORIZON DR
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City | MALIBU
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State | CA
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Zip | 90265-3755
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Country | US
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Telephone | 424-217-1052
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Fax |
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Provider Business Mailing Address
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Address Line | 29160 HEATHERCLIFF RD STE 200
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City | MALIBU
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State | CA
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Zip | 90265-6306
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Country | US
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Telephone | 424-217-1052
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Fax | 424-217-1052
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Authorized Official
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Title or Position | CEO
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Name | MS. KELLY STEPHENSON
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Credential |
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Telephone | 310-579-1004
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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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