Provider Demographics
NPI:1831541986
Name:TIKVA TREATMENT LLC
Entity type:Organization
Organization Name:TIKVA TREATMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:805-202-3440
Mailing Address - Street 1:391 FRONT STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433
Mailing Address - Country:US
Mailing Address - Phone:805-202-3440
Mailing Address - Fax:805-202-3441
Practice Address - Street 1:621 E GRANDE AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-202-3440
Practice Address - Fax:805-202-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400009BP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA400009BPOtherSTATE OF CALIFORNIA DEPT OF HEALTH