Provider Demographics
NPI:1477844462
Name:SEASONS RECOVERY CENTERS-ACUPUNCTURE
Entity Type:Organization
Organization Name:SEASONS RECOVERY CENTERS-ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BATHUM
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:818-635-9380
Mailing Address - Street 1:30245 PACIFIC COAST HWY
Mailing Address - Street 2:30245 PACIFIC COAST HIGHWAY
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3603
Mailing Address - Country:US
Mailing Address - Phone:818-635-9380
Mailing Address - Fax:
Practice Address - Street 1:30245 PACIFIC COAST HWY
Practice Address - Street 2:30245 PACIFIC COAST HIGHWAY
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3603
Practice Address - Country:US
Practice Address - Phone:818-635-9380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15523324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility