Provider Demographics
NPI:1831653617
Name:JOURNEY HILLSIDE TARZANA, LLC
Entity Type:Organization
Organization Name:JOURNEY HILLSIDE TARZANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ASSAD
Authorized Official - Middle Name:ULLAH
Authorized Official - Last Name:KAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-517-5103
Mailing Address - Street 1:4706 VIVIANA DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5039
Mailing Address - Country:US
Mailing Address - Phone:818-996-6005
Mailing Address - Fax:
Practice Address - Street 1:4706 VIVIANA DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-5039
Practice Address - Country:US
Practice Address - Phone:818-996-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit