Provider Demographics
NPI:1972807402
Name:BELLA LA VITA COMPANY
Entity Type:Organization
Organization Name:BELLA LA VITA COMPANY
Other - Org Name:JOURNEY MALIBU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLAIMS ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-648-2570
Mailing Address - Street 1:22516 CARBON MESA RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5019
Mailing Address - Country:US
Mailing Address - Phone:310-456-2551
Mailing Address - Fax:
Practice Address - Street 1:22516 CARBON MESA RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5019
Practice Address - Country:US
Practice Address - Phone:310-456-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190688AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility