Malibu Behavioral Health Services Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

330128AP Issued in CA

Legal business name

MALIBU BEHAVIORAL HEALTH SERVICES INC

Doing business as

'South California Road to Recovery'

Practice address

7057 Gaskin PL
Riverside, CA 92506-5615

Phone

(951) 776-8869

Fax

(951) 215-0881

NPI assigned

Feb 6, 2014

Last updated

Sep 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angelika Panova, PMHNP-RN, LMFTNPI 1992936678

Title

Executive Manager

Phone

(714) 887-3816

Specialties & licenses 4

Addresses

Other names 1

• 'South California Road to Recovery' Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

'South California Road to Recovery'2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Malibu Behavioral Health Services Inc

  • Marriage & Family Therapist
  • Riverside, CA
  • NPI 1669333845
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angelika Panova, MHPNP-RN/ LMFT

  • Psychiatric/Mental Health Nurse Practitioner
  • Riverside, CA
  • NPI 1992936678

  Marriage & Family Therapist

  NPD (past) Authorized official
• Shannon Michal Lance, ACSW

  • Social Worker
  • Riverside, CA
  • NPI 1265393094
  NPD (past)

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

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1225452691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 E IMPERIAL HWY APT 226",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928701717",
            "telephone_number": "951-215-0881",
            "fax_number": "951-215-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7057 GASKIN PL",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925065615",
            "telephone_number": "951-776-8869",
            "fax_number": "951-215-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALIBU BEHAVIORAL HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-06",
        "last_updated": "2024-09-05",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "PANOVA",
        "authorized_official_first_name": "ANGELIKA",
        "authorized_official_title_or_position": "EXECUTIVE MANAGER",
        "authorized_official_telephone_number": "714-887-3816",
        "authorized_official_credential": "PMHNP-RN, LMFT"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "330128AP",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "49586",
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "804708",
            "primary": false
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "CA",
            "license": "804708",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "'South California Road to Recovery'",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mohammad Malekzadegan
• Aysouda Malekzadeh, DO
• Reechie Maleon
• Rishi Malhotra, BS
• Leika Malia
• Malibu Behavioral Health Services Inc
• Shaishta Malik, RN
• Benedict James San Jose Malinao, FNP-C
• Armen Masis Malkhasian, MD
• Nicholas Malkus

• Substance Abuse Rehabilitation Facility in Riverside, CA
• Providers in Riverside, 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 Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.