Provider Demographics
NPI:1588831432
Name:MALIBU BEACH RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:MALIBU BEACH RECOVERY CENTER, LLC
Other - Org Name:MALIBU BEACH RECOVERY CENTER - CORRAL CANYON
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MBA
Authorized Official - Phone:470-440-1647
Mailing Address - Street 1:2300 WINDY RIDGE PARKWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-440-1647
Mailing Address - Fax:678-813-0505
Practice Address - Street 1:1752 CORRAL CANYON RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2906
Practice Address - Country:US
Practice Address - Phone:310-456-2026
Practice Address - Fax:310-456-6528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-09
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190562AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility