Provider Demographics
NPI:1225585664
Name:TIKVA TREATMENT
Entity Type:Organization
Organization Name:TIKVA TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-502-6991
Mailing Address - Street 1:170 NELSON STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420
Mailing Address - Country:US
Mailing Address - Phone:805-202-3440
Mailing Address - Fax:888-510-9071
Practice Address - Street 1:170 NELSON STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-202-3440
Practice Address - Fax:888-510-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400009CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA400009CPOtherDEPARTMENT OF HEALTH CARE SERVICES
CA400009APOtherDEPARTMENT OF HEALTH CARE SERVICES
CA400009BPOtherDEPARTMENT OF HEALTH CARE SERVICES