Provider Demographics
NPI:1033596291
Name:TOPANGA ROSCOE CORPORATION
Entity Type:Organization
Organization Name:TOPANGA ROSCOE CORPORATION
Other - Org Name:ACT HEALTH & WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-884-8100
Mailing Address - Street 1:15760 VENTURA BLVD
Mailing Address - Street 2:SUITE 920
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3019
Mailing Address - Country:US
Mailing Address - Phone:818-884-8100
Mailing Address - Fax:818-884-7808
Practice Address - Street 1:15760 VENTURA BLVD
Practice Address - Street 2:SUITE 920
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3019
Practice Address - Country:US
Practice Address - Phone:818-884-8100
Practice Address - Fax:818-884-7808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOPANGA ROSCOE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-27
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACX569AMedicare PIN