Provider Demographics
NPI:1568997633
Name:MANIFEST VALLEY WELLNESS, LLC
Entity Type:Organization
Organization Name:MANIFEST VALLEY WELLNESS, LLC
Other - Org Name:MANIFEST RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-905-4455
Mailing Address - Street 1:22647 VENTURA BLVD
Mailing Address - Street 2:UNIT 446
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1416
Mailing Address - Country:US
Mailing Address - Phone:310-905-4455
Mailing Address - Fax:
Practice Address - Street 1:18663 VENTURA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4162
Practice Address - Country:US
Practice Address - Phone:818-963-9319
Practice Address - Fax:818-657-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health