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General NPI Number Information
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NPI Number | 1831591882
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Entity Type | Organization
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Legal Business Name | MT RENFIELD LLC
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 17635 VANOWEN ST
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City | VAN NUYS
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State | CA
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Zip | 91406-4353
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Country | US
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Telephone | 888-962-8208
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Fax |
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Provider Business Mailing Address
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Address Line | 2390 LAS POSAS RD STE C STE 500
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City | CAMARILLO
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State | CA
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Zip | 93010-3437
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Country | US
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Telephone | 818-970-4464
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MRS. MCKAY WHITING
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Credential |
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Telephone | 818-970-4464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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