Provider Demographics
NPI:1821375973
Name:MALIBU CALIFORNIA MODEL DRUG TREATMENT CENTER, INC
Entity Type:Organization
Organization Name:MALIBU CALIFORNIA MODEL DRUG TREATMENT CENTER, INC
Other - Org Name:INSPIRE MALIBU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:ROMA
Authorized Official - Last Name:SARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-292-9213
Mailing Address - Street 1:30101 AGOURA CT STE 103
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3875 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-3210
Practice Address - Country:US
Practice Address - Phone:818-707-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190729AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility