MEDICARE: WISDOM TREATMENT, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190887AP	OTHER	CA	CALIFORNIA CERTIFICATION

General Provider Information

NPI Number	:	1700258829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISDOM TREATMENT, LLC

Provider Business Mailing Address
First Line	:	7361 TOPANGA CANYON BLVD
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-3387
Country	:	US
Telephone Number	:	818-489-4592
Fax Number	:

Provider Business Practice Location Address
First Line	:	7361 TOPANGA CANYON BLVD
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-3387
Country	:	US
Telephone Number	:	818-489-4592
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	AARON BARSALOU
Credential	:
Telephone Number	:	818-489-4592

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	10/26/2020

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Directions to “WISDOM TREATMENT, LLC ” Practice Location

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