Provider Demographics
NPI:1326341850
Name:RYLIST, INC.
Entity Type:Organization
Organization Name:RYLIST, INC.
Other - Org Name:LA VENTANA EATING DISORDERS PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZAMARRIPAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8805-777-3873
Mailing Address - Street 1:275 E HILLCREST DR
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5827
Mailing Address - Country:US
Mailing Address - Phone:805-777-3813
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE # N 265
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:805-777-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22303261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health