Provider Demographics
NPI:1972275097
Name:HEALING TREE REHAB, INC,
Entity Type:Organization
Organization Name:HEALING TREE REHAB, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:626-318-0274
Mailing Address - Street 1:6969 VISTA DEL RINCON DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-9782
Mailing Address - Country:US
Mailing Address - Phone:626-308-0274
Mailing Address - Fax:805-830-1755
Practice Address - Street 1:6969 VISTA DEL RINCON DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-9782
Practice Address - Country:US
Practice Address - Phone:626-308-0274
Practice Address - Fax:805-830-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility