Provider Demographics
NPI:1700249430
Name:MOTION PICTURE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MOTION PICTURE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-427-4897
Mailing Address - Street 1:5210 VISTA MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1811
Mailing Address - Country:US
Mailing Address - Phone:626-487-3417
Mailing Address - Fax:626-844-6636
Practice Address - Street 1:5210 VISTA MIGUEL DR
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-1811
Practice Address - Country:US
Practice Address - Phone:626-487-3417
Practice Address - Fax:626-844-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility