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General NPI Number Information
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NPI Number | 1801319967
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Entity Type | Organization
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Legal Business Name | MALIBU BEACH RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 101 S SALTAIR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90049-4114
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Country | US
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Telephone | 678-813-0505
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Fax | 678-813-0505
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Provider Business Mailing Address
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Address Line | 2300 WINDY RIDGE PKWY #210 SOUTH
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City | ATLANTA
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State | GA
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Zip | 30339
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Country | US
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Telephone | 678-813-0505
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Fax | 678-813-0505
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Authorized Official
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Title or Position | DIRECTOR OF RCM
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Name | JEAN ANN DOCKERY
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Credential |
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Telephone | 678-813-0505
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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 | 190562CP
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License Number State | CA
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