Provider Demographics
NPI:1891055802
Name:CANYON AT SANTA MONICA
Entity Type:Organization
Organization Name:CANYON AT SANTA MONICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP-CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-382-3319
Mailing Address - Street 1:1000 HEALTH PARK DRIVE
Mailing Address - Street 2:BUILDING THREE, SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-386-7255
Mailing Address - Fax:615-645-7445
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:615-345-3200
Practice Address - Fax:615-373-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190746AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility