Provider Demographics
NPI:1437722014
Name:SOCAL TRANSITIONAL LIVING LLC
Entity Type:Organization
Organization Name:SOCAL TRANSITIONAL LIVING LLC
Other - Org Name:PURPOSES RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZKALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-926-1982
Mailing Address - Street 1:7239 KENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1255
Mailing Address - Country:US
Mailing Address - Phone:818-926-1982
Mailing Address - Fax:
Practice Address - Street 1:7239 KENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1255
Practice Address - Country:US
Practice Address - Phone:800-300-2026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder