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General NPI Number Information
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NPI Number | 1831551423
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Entity Type | Organization
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Legal Business Name | LUXURY REHAB GROUP, LLC.
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 5850 LAPWORTH DR
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1858
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Country | US
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Telephone | 747-222-7802
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 LAPWORTH DR
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1858
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | SHEILA SHILATI
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Credential |
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Telephone | 424-234-2060
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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 | 190655CP
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License Number State | CA
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