Provider Demographics
NPI:1033262811
Name:EDE CA AT SANTA MONICA, LP
Entity Type:Organization
Organization Name:EDE CA AT SANTA MONICA, LP
Other - Org Name:A NEW JOURNEY EATING DISORDER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:TYEAST
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-813-0428
Mailing Address - Street 1:2300 WINDY RIDGE PARKWAY
Mailing Address - Street 2:SUITE 210S
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-440-1647
Mailing Address - Fax:310-829-9055
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 3020
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5225
Practice Address - Country:US
Practice Address - Phone:310-829-9161
Practice Address - Fax:310-829-9055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty