Pacific Teen Treatment LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

PACIFIC TEEN TREATMENT LLC

Practice address

29053 Pacific Coast Hwy
Malibu, CA 90265-3948

Phone

(917) 662-7192

NPI assigned

Oct 8, 2018

Organization subpart

No

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

Authorized official

Name

Jeremy Manne

Title

Ceo

Phone

(917) 662-7192

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538956800000",
    "number": "1336614296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29053 PACIFIC COAST HWY",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902653948",
            "telephone_number": "917-662-7192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29053 PACIFIC COAST HWY",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902653948",
            "telephone_number": "917-662-7192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC TEEN TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-08",
        "last_updated": "2018-10-08",
        "status": "A",
        "authorized_official_last_name": "MANNE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-662-7192"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Malibu, CA
• Providers in Malibu, CA by specialty
• Adolescent and Children Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; 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.