Provider Demographics
NPI:1508008582
Name:MALIBU LIGHTHOUSE TREATMENT CENTERS
Entity Type:Organization
Organization Name:MALIBU LIGHTHOUSE TREATMENT CENTERS
Other - Org Name:SUMMIT MALIBU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-457-0787
Mailing Address - Street 1:31544 ANACAPA VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:310-457-0787
Mailing Address - Fax:
Practice Address - Street 1:31544 ANACAPA VIEW DR
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2604
Practice Address - Country:US
Practice Address - Phone:310-457-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MALIBU LIGHTHOUSE TREATMENT CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190612BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility