Provider Demographics
NPI:1083958177
Name:MALIBU BALANCE DAY TREATMENT
Entity Type:Organization
Organization Name:MALIBU BALANCE DAY TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-880-0800
Mailing Address - Street 1:4505 LAS VIRGENES RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-880-0800
Mailing Address - Fax:818-880-0808
Practice Address - Street 1:4505 LAS VIRGENES RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1956
Practice Address - Country:US
Practice Address - Phone:818-880-0800
Practice Address - Fax:818-880-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital