Provider Demographics
NPI: | 1760953194 |
---|---|
Name: | PB CALIFORNIA REHAB AND RECOVERY, LLC |
Entity Type: | Organization |
Organization Name: | PB CALIFORNIA REHAB AND RECOVERY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FLOYD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 847-329-4100 |
Mailing Address - Street 1: | 7444 LONG AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SKOKIE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60077-3214 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-329-4100 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 20713 ROCKCROFT DR |
Practice Address - Street 2: | |
Practice Address - City: | MALIBU |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90265-5343 |
Practice Address - Country: | US |
Practice Address - Phone: | 310-317-9233 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-12-11 |
Last Update Date: | 2018-12-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |