Provider Demographics
NPI:1639887326
Name:CHANNEL ISLANDS REHAB, LLC
Entity type:Organization
Organization Name:CHANNEL ISLANDS REHAB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-934-8999
Mailing Address - Street 1:4744 TELEPHONE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5258
Mailing Address - Country:US
Mailing Address - Phone:214-934-8999
Mailing Address - Fax:805-834-0288
Practice Address - Street 1:4474 MARKET ST STE 505
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5812
Practice Address - Country:US
Practice Address - Phone:805-218-0079
Practice Address - Fax:805-834-0288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANNEL ISLANDS REHAB, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-10
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861046468OtherPRIVATE INSURANCE