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General NPI Number Information
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NPI Number | 1972275097
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Entity Type | Organization
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Legal Business Name | HEALING TREE REHAB, INC,
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 6969 VISTA DEL RINCON DR
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City | VENTURA
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State | CA
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Zip | 93001-9782
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Country | US
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Telephone | 626-308-0274
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Fax | 805-830-1755
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Provider Business Mailing Address
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Address Line | 6969 VISTA DEL RINCON DR
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City | VENTURA
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State | CA
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Zip | 93001-9782
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Country | US
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Telephone | 626-308-0274
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Fax | 805-830-1755
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. BRIAN W. KELLOGG
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Credential | J.D.
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Telephone | 626-318-0274
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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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