Provider Demographics
NPI:1700136264
Name:CENTER FOR MINDFUL CHANGE, LLC.
Entity Type:Organization
Organization Name:CENTER FOR MINDFUL CHANGE, LLC.
Other - Org Name:MULHOLLAND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-710-4000
Mailing Address - Street 1:26066 MULHOLLAND HWY
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1916
Mailing Address - Country:US
Mailing Address - Phone:818-878-0888
Mailing Address - Fax:818-878-9612
Practice Address - Street 1:26066 MULHOLLAND HWY
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1916
Practice Address - Country:US
Practice Address - Phone:818-878-0888
Practice Address - Fax:818-878-9612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility