Axis Residential Treatment - West

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

190727AP Issued in CA

Legal business name

AXIS RESIDENTIAL TREATMENT - WEST

Practice address

4024 Huron Ave
Culver City, CA 90232-4017

Phone

(310) 838-3640

NPI assigned

Feb 29, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brad Keith, CADAC

Title

Ceo/Owner

Phone

(310) 435-6298

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330473600000",
    "number": "1033483615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4024 HURON AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902324017",
            "telephone_number": "310-838-3640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4024 HURON AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902324017",
            "telephone_number": "310-838-3640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS RESIDENTIAL TREATMENT - WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2012-02-29",
        "status": "A",
        "authorized_official_last_name": "KEITH",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "310-435-6298",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADAC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190727AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Culver City, CA
• Providers in Culver City, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.