Provider Demographics
NPI:1710513593
Name:WHITE OAK RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:WHITE OAK RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-342-9430
Mailing Address - Street 1:20112 STARE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3917
Mailing Address - Country:US
Mailing Address - Phone:704-450-2117
Mailing Address - Fax:
Practice Address - Street 1:20112 STARE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3917
Practice Address - Country:US
Practice Address - Phone:704-450-2117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility