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NPI Code Detail

MEDICARE: CLARE MATRIX

MEDICARE: CLARE MATRIX
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
1324500000XSubstance Abuse Rehabilitation Facility190016HNCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1190016FNOTHERCASTATE LICENSE

General Provider Information

NPI Number : 1851645394
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARE MATRIX
Provider Business Mailing Address
First Line : 909 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1326
Country : US
Telephone Number : 310-314-6200
Fax Number : 310-450-2024
Provider Business Practice Location Address
First Line : 844 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1325
Country : US
Telephone Number : 310-314-6200
Fax Number : 310-450-2024
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : STEVE GLICK
Credential :
Telephone Number : 310-314-6200
Provider Enumeration Date : 11/06/2012
Last Update Date : 05/23/2023

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1730624602 — LESLIE GOODWIN
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1649791625 — ADRIAN PATRICE REEVES
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Directions to “CLARE MATRIX ” Practice Location

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