Provider Demographics
NPI:1053700948
Name:INFINITY MALIBU LLC
Entity type:Organization
Organization Name:INFINITY MALIBU LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYADZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-807-3729
Mailing Address - Street 1:27475 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4477
Mailing Address - Country:US
Mailing Address - Phone:818-465-3988
Mailing Address - Fax:
Practice Address - Street 1:27475 WINDING WAY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4477
Practice Address - Country:US
Practice Address - Phone:818-465-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility