Passages Malibu PHP, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

190835AP Issued in CA

Legal business name

PASSAGES MALIBU PHP, LLC

Doing business as

Passages Venice

Practice address

1728 Abbot Kinney Blvd
#103
Venice, CA 90291-4839

Phone

(866) 619-7013

NPI assigned

Jul 24, 2015

Organization subpart

No

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

Authorized official

Name

Marina Jo Mahoney

Title

Coo

Phone

(310) 589-2880

Specialties & licenses 1

Addresses

Other names 1

• Passages Venice Doing business as

Locations

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1356726913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6428 MEADOWS CT",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902654492",
            "telephone_number": "310-589-2880",
            "fax_number": "310-464-6933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 ABBOT KINNEY BLVD",
            "address_2": "#103",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902914839",
            "telephone_number": "866-619-7013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAGES MALIBU PHP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-24",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "MAHONEY",
        "authorized_official_first_name": "MARINA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "310-589-2880"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190835AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passages Venice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexander Pappas, MD
• Noushin Parham, J.D.
• Rujuta Parikh
• Amy Maria Starlight Parsons, M.S. CCC/SLP
• Susan Mojdeh Partovi, M.D.
• Rutambhar Patel, D.C.
• Oshgene Patterson
• Eric Paulson
• Joel Perez Jr.
• Victor Hugo Perez, M.D.

• Substance Abuse Rehabilitation Facility in Venice, CA
• Providers in Venice, 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 Jul 24, 2015; 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.