Provider Demographics
NPI:1114388840
Name:CAST CENTERS LLC
Entity Type:Organization
Organization Name:CAST CENTERS LLC
Other - Org Name:CAST RECOVERY SERVICES OF SANTA MONICA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-873-3935
Mailing Address - Street 1:630 N DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-5506
Mailing Address - Country:US
Mailing Address - Phone:310-873-3935
Mailing Address - Fax:310-564-1883
Practice Address - Street 1:630 N DOHENY DR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5506
Practice Address - Country:US
Practice Address - Phone:310-873-3935
Practice Address - Fax:310-564-1883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAST HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder