Provider Demographics
NPI:1831591882
Name:MT RENFIELD LLC
Entity type:Organization
Organization Name:MT RENFIELD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MCKAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-970-4464
Mailing Address - Street 1:2390 LAS POSAS RD STE C
Mailing Address - Street 2:STE 500
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3437
Mailing Address - Country:US
Mailing Address - Phone:818-970-4464
Mailing Address - Fax:
Practice Address - Street 1:17635 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4353
Practice Address - Country:US
Practice Address - Phone:888-962-8208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder