Provider Demographics
NPI:1831314251
Name:TOPANGA ROSCOE CORPORATION
Entity Type:Organization
Organization Name:TOPANGA ROSCOE CORPORATION
Other - Org Name:TOPANGA WEST GUEST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-884-8100
Mailing Address - Street 1:22115 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-3839
Mailing Address - Country:US
Mailing Address - Phone:818-884-8100
Mailing Address - Fax:818-884-7808
Practice Address - Street 1:22115 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-3839
Practice Address - Country:US
Practice Address - Phone:818-884-8100
Practice Address - Fax:818-884-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191202140320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7283Medicaid
CACX569AMedicare PIN
CX569AMedicare UPIN