Provider Demographics
NPI:1114532660
Name:MALIBU SEASIDE SERENITY COVE, INC.
Entity Type:Organization
Organization Name:MALIBU SEASIDE SERENITY COVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-346-0088
Mailing Address - Street 1:6134 BUSCH DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3833
Mailing Address - Country:US
Mailing Address - Phone:310-457-7919
Mailing Address - Fax:
Practice Address - Street 1:6134 BUSCH DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3833
Practice Address - Country:US
Practice Address - Phone:310-457-7919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility