Provider Demographics
NPI:1073754784
Name:REALIZATION CENTER LLC
Entity Type:Organization
Organization Name:REALIZATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-880-2193
Mailing Address - Street 1:23853 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 540
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:818-880-2193
Mailing Address - Fax:
Practice Address - Street 1:26066 MULHOLLAND HWY
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1916
Practice Address - Country:US
Practice Address - Phone:818-880-2193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190663AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190663APOtherCALIFORNIA DEPARTMENT OF DRUG AND ALCOHOL PROGRAMS