Provider Demographics
NPI:1053701425
Name:CHANGING TIDES TREATMENT LLC
Entity type:Organization
Organization Name:CHANGING TIDES TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERKELEY
Authorized Official - Middle Name:BEAUDEAN
Authorized Official - Last Name:DAINS
Authorized Official - Suffix:
Authorized Official - Credentials:CATC, CIP,BS
Authorized Official - Phone:805-506-1541
Mailing Address - Street 1:5301 SEABREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1048
Mailing Address - Country:US
Mailing Address - Phone:844-883-3869
Mailing Address - Fax:805-624-5311
Practice Address - Street 1:2021 SPERRY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7408
Practice Address - Country:US
Practice Address - Phone:844-883-3869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health