Provider Demographics
NPI:1093156879
Name:CAST RECOVERY SERVICES OF SANTA MONICA, INC
Entity Type:Organization
Organization Name:CAST RECOVERY SERVICES OF SANTA MONICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GARDINER
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II, BRI II
Authorized Official - Phone:310-873-3935
Mailing Address - Street 1:530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1421
Mailing Address - Country:US
Mailing Address - Phone:310-873-3935
Mailing Address - Fax:310-564-1883
Practice Address - Street 1:530 WILSHIRE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1421
Practice Address - Country:US
Practice Address - Phone:310-873-3935
Practice Address - Fax:310-564-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty