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General NPI Number Information
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NPI Number | 1851526354
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Entity Type | Organization
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Legal Business Name | MERIDIAN TREATMENT CENTER
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 24389 DRY CANYON COLD CREEK RD
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City | CALABASAS
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State | CA
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Zip | 91302-3209
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Country | US
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Telephone | 818-914-6283
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6191
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City | THOUSAND OAKS
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State | CA
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Zip | 91359-6191
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Country | US
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Telephone | 818-914-6283
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. GINA PETRUS
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Credential | PHD
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Telephone | 818-914-6283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 198205794
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License Number State | CA
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