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General NPI Number Information
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NPI Number | 1992134084
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Entity Type | Organization
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Legal Business Name | ACADIA MALIBU, INC.
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 5922 PHILIP AVE
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City | MALIBU
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State | CA
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Zip | 90265-3745
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Country | US
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Telephone | 310-579-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 30765 PACIFIC COAST HWY #135
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City | MALIBU
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State | CA
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Zip | 90265-3646
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JARED VALENTINE
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Credential |
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Telephone | 310-579-5192
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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 | 190786AP
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License Number State | CA
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