Provider Demographics
NPI:1770038663
Name:TIKVA TREATMENT
Entity Type:Organization
Organization Name:TIKVA TREATMENT
Other - Org Name:THE HAVEN AT PISMO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-502-6991
Mailing Address - Street 1:2030 IDYLLWILD PL
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-9601
Mailing Address - Country:US
Mailing Address - Phone:805-202-3440
Mailing Address - Fax:888-510-9071
Practice Address - Street 1:2030 IDYLLWILD PL
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-9601
Practice Address - Country:US
Practice Address - Phone:805-202-3440
Practice Address - Fax:888-510-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400009CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA400009CPOtherSTATE OF CALIFORNIA DEPT OF HEALTH