Provider Demographics
NPI:1225587629
Name:MALIBU OUTPATIENT INC
Entity Type:Organization
Organization Name:MALIBU OUTPATIENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-579-6063
Mailing Address - Street 1:30765 PACIFIC COAST HWY
Mailing Address - Street 2:STE 135
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28955 PACIFIC COAST HWY
Practice Address - Street 2:STE 210
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3953
Practice Address - Country:US
Practice Address - Phone:310-579-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health