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General NPI Number Information
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NPI Number | 1962867804
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Entity Type | Organization
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Legal Business Name | PASSAGES BEVERLYWOOD LLC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 2370 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90034-2029
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Country | US
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Telephone | 310-589-2880
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Fax | 310-589-2858
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Provider Business Mailing Address
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Address Line | 6428 MEADOWS CT
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City | MALIBU
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State | CA
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Zip | 90265-4492
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Country | US
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Telephone | 310-589-2880
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Fax | 310-589-2858
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Authorized Official
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Title or Position | CEO
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Name | MR. PAX PRENTISS
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Credential |
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Telephone | 310-589-2880
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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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