Provider Demographics
NPI:1417143280
Name:CRC CALIFORNIA RD, INC.
Entity Type:Organization
Organization Name:CRC CALIFORNIA RD, INC.
Other - Org Name:ECHO MALIBU
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-589-2090
Mailing Address - Street 1:PO BOX 2911
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-7911
Mailing Address - Country:US
Mailing Address - Phone:310-589-2090
Mailing Address - Fax:310-589-5040
Practice Address - Street 1:20600 EAGLEPASS DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5211
Practice Address - Country:US
Practice Address - Phone:310-589-2090
Practice Address - Fax:310-589-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA198205839323P00000X, 324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility