Provider Demographics
NPI:1720283096
Name:LAS VIRGENES BEHAVIORAL HEALTH AND MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:LAS VIRGENES BEHAVIORAL HEALTH AND MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHMELEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-879-9018
Mailing Address - Street 1:30101 AGOURA CT STE 100
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4301
Mailing Address - Country:US
Mailing Address - Phone:818-879-9018
Mailing Address - Fax:818-879-9013
Practice Address - Street 1:30101 AGOURA CT STE 100
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4301
Practice Address - Country:US
Practice Address - Phone:818-879-9018
Practice Address - Fax:818-879-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty