Provider Demographics
NPI:1497183503
Name:PARADIGM TREATMENT CENTERS INC.
Entity Type:Organization
Organization Name:PARADIGM TREATMENT CENTERS INC.
Other - Org Name:PARADIGM MALIBU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-710-4000
Mailing Address - Street 1:6323 VIA ESCONDIDO DR
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4484
Mailing Address - Country:US
Mailing Address - Phone:310-457-6300
Mailing Address - Fax:310-457-6318
Practice Address - Street 1:6323 VIA ESCONDIDO DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4484
Practice Address - Country:US
Practice Address - Phone:310-457-6300
Practice Address - Fax:310-457-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323P00000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children