NPIMap

Organization Active NPI

Malibu Beach Recovery Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Los Angeles, CA
National Provider Identifier
1801319967
Registry record updated Sep 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
190562CP Issued in CA
Legal business name
MALIBU BEACH RECOVERY CENTER, LLC
Practice address
101 S Saltair Ave
Los Angeles, CA 90049-4114
Phone
(678) 813-0505
Fax
(678) 813-0505
NPI assigned
Jul 20, 2017
Organization subpart
Yes
Parent organization
RIVERMEND HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2017

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

Authorized official

Name
Jean Ann Dockery
Title
Director of RCM
Phone
(678) 813-0505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 190562CP CA Primary

Addresses

Primary practice location

101 S Saltair Ave
Los Angeles, CA 90049-4114

Mailing address

2300 Windy Ridge Pkwy #210 South
Atlanta, GA 30339
Phone (678) 813-0505

Other names 1

  • Malibu Beach Recovery Center - Brentwood House Other name

National Provider Directory

National Provider Directory
Tax ID family
Malibu Beach Recovery Center LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

2300 Windy Ridge Pkwy SE
Ste 210S
Atlanta, GA 30339
Phone (678) 813-0505

NPI Registry JSON

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504828800000",
    "number": "1801319967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 WINDY RIDGE PKWY #210 SOUTH",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30339",
            "telephone_number": "678-813-0505",
            "fax_number": "678-813-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S SALTAIR AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900494114",
            "telephone_number": "678-813-0505",
            "fax_number": "678-813-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALIBU BEACH RECOVERY CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERMEND HEALTH, LLC",
        "enumeration_date": "2017-07-20",
        "last_updated": "2017-09-08",
        "status": "A",
        "authorized_official_last_name": "DOCKERY",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR OF RCM",
        "authorized_official_telephone_number": "678-813-0505"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "190562CP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malibu Beach Recovery Center - Brentwood House",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Malibu Beach Recovery Center - Brentwood House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2017; 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.