Provider Demographics
NPI:1992843767
Name:OCEANAIRE RESIDENTIAL TREATMENT PROGRAM
Entity Type:Organization
Organization Name:OCEANAIRE RESIDENTIAL TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORCASITA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-543-1010
Mailing Address - Street 1:30175 AVENIDA TRANQUILA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4516
Mailing Address - Country:US
Mailing Address - Phone:310-543-1010
Mailing Address - Fax:310-543-9090
Practice Address - Street 1:30175 AVENIDA TRANQUILA
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-4516
Practice Address - Country:US
Practice Address - Phone:310-543-1010
Practice Address - Fax:310-543-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility