Provider Demographics
NPI:1609224823
Name:SIESTA HOUSE, LLC
Entity Type:Organization
Organization Name:SIESTA HOUSE, LLC
Other - Org Name:VENTURA RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/TRUSTEE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-247-6111
Mailing Address - Street 1:555 SAINT CHARLES DR STE 103
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3988
Mailing Address - Country:US
Mailing Address - Phone:800-247-6111
Mailing Address - Fax:805-372-1912
Practice Address - Street 1:2985 E HILLCREST DR STE 106
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3179
Practice Address - Country:US
Practice Address - Phone:800-247-6111
Practice Address - Fax:805-494-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder