Provider Demographics
NPI:1093182198
Name:RECOVERY MALIBU, INC.
Entity Type:Organization
Organization Name:RECOVERY MALIBU, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-568-7667
Mailing Address - Street 1:18401 VON KARMAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8531
Mailing Address - Country:US
Mailing Address - Phone:714-828-1800
Mailing Address - Fax:714-882-1186
Practice Address - Street 1:20723 ROCKCROFT DR.
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:424-388-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190859AP324500000X
CA190075AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility