The Canyon at Peace Park, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

190441BP Issued in CA

Legal business name

THE CANYON AT PEACE PARK, LLC

Practice address

2900 S. Kanan Dume Road
Malibu, CA 90265-2792

Phone

(310) 457-3209

Fax

(310) 457-4440

NPI assigned

Jun 20, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Kathleen Bigsby, PHD, MSW

Title

Chief Executive Officer

Phone

(310) 457-3209

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Angela Lynn Hudson, PMHNP, FNP, PHD

  • Psychiatric/Mental Health Nurse Practitioner
  • Los Alamitos, CA
  • NPI 1750891446
  NPD (past)

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249516800000",
    "number": "1437310695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WESTWOOD PLACE,",
            "address_2": "SUITE 120",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277554",
            "telephone_number": "615-342-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 S. KANAN DUME ROAD",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902652792",
            "telephone_number": "310-457-3209",
            "fax_number": "310-457-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CANYON AT PEACE PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2009-08-06",
        "status": "A",
        "authorized_official_last_name": "BIGSBY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-457-3209",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHD, MSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190441BP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corie Tappin, L.AC.
• Alanna Eileen Tarkington, MFT
• Tcsrzs Holdings LLC
• Telehealth Innovation
• Claudia Tellier, MD
• The Emergency Group, Inc
• The Regents of the University of California
• Annabel Thomson, PSYD, LMFT, ATR
• Thrive Malibu LLC
• Elizabeth Margretha Topp, PSY 34398

• Substance Abuse Rehabilitation Facility in Malibu, CA
• Providers in Malibu, 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 Aug 6, 2009; 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.