Provider Demographics
NPI:1457630741
Name:OCEANSIDE TRANSITIONAL LIVING IN MALIBU
Entity Type:Organization
Organization Name:OCEANSIDE TRANSITIONAL LIVING IN MALIBU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-917-7239
Mailing Address - Street 1:21022 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5242
Mailing Address - Country:US
Mailing Address - Phone:310-456-3355
Mailing Address - Fax:310-456-3305
Practice Address - Street 1:21022 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5242
Practice Address - Country:US
Practice Address - Phone:310-456-3355
Practice Address - Fax:310-456-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility