Service Industries, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

190069AP Issued in CA

Legal business name

SERVICE INDUSTRIES, INC.

Doing business as

Cliffside Malibu Outpatient Services - Sherman Oaks

Practice address

15250 Ventura Blvd
Suite 1100
Sherman Oaks, CA 91403

Phone

(424) 217-1052

Fax

(310) 456-1860

NPI assigned

Jul 15, 2015

Organization subpart

No

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

Authorized official

Name

Ms. Kelly Stephenson

Title

Chief Operating Officer

Phone

(310) 579-1004

Specialties & licenses 2

Addresses

Other names 1

• Cliffside Malibu Outpatient Services - Sherman Oaks Doing business as

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1528442936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29160 HEATHERCLIFF RD., STE. 200",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "90265",
            "telephone_number": "424-217-1052",
            "fax_number": "310-456-1860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15250 VENTURA BLVD",
            "address_2": "SUITE 1100",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "91403",
            "telephone_number": "424-217-1052",
            "fax_number": "310-456-1860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERVICE INDUSTRIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "310-579-1004",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "190856AP",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "190069AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cliffside Malibu Outpatient Services - Sherman Oaks",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Serata, PA-C
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• Jessica Darlene Sevilla
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• Zebo Shaazizova
• Jacob Shab

• Substance Use Disorder Rehabilitation Clinic/Center in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.