MEDICARE: SANCTUARY TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1386001071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANCTUARY TREATMENT CENTER

Provider Business Mailing Address
First Line	:	4815 WOODLEY AVE
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-1406
Country	:	US
Telephone Number	:	818-646-3280
Fax Number	:

Provider Business Practice Location Address
First Line	:	4815 WOODLEY AVE
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-1406
Country	:	US
Telephone Number	:	818-646-3280
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELLIOTT LIEBHARD
Credential	:
Telephone Number	:	818-646-3280

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	09/13/2017

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Directions to “SANCTUARY TREATMENT CENTER ” Practice Location

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