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General NPI Number Information
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NPI Number | 1831021674
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Entity Type | Organization
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Legal Business Name | WHITE OAK RECOVERY CENTER OUTPATIENT LLC
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 6023 HAZELTINE AVE
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City | VAN NUYS
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State | CA
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Zip | 91401-3525
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Country | US
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Telephone | 704-838-9222
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Fax | 910-408-0887
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Provider Business Mailing Address
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Address Line | 4009 MASONBORO LOOP RD
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City | WILMINGTON
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State | NC
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Zip | 28409-3640
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Country | US
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Telephone | 704-838-9222
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Fax | 910-408-0887
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Authorized Official
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Title or Position | CEO
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Name | KEATON WEBER
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Credential |
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Telephone | 704-838-9222
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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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