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General NPI Number Information
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NPI Number | 1972091999
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Entity Type | Organization
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Legal Business Name | FOUNDATION BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 222 AMALFI DR
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City | SANTA MONICA
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State | CA
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Zip | 90402
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Country | US
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Telephone | 949-565-6197
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Fax |
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Provider Business Mailing Address
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Address Line | 222 AMALFI DR
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City | SANTA MONICA
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State | CA
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Zip | 90402-1126
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Country | US
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Telephone | 949-565-6197
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | HOWARD GOODMAN
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Credential | LMFT
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Telephone | 866-236-0968
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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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