Provider Demographics
NPI:1053873224
Name:CASABLANCA OUTPATIENT
Entity type:Organization
Organization Name:CASABLANCA OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-731-2738
Mailing Address - Street 1:11319 OVERLOOK TRL
Mailing Address - Street 2:
Mailing Address - City:KAGEL CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6200
Mailing Address - Country:US
Mailing Address - Phone:818-731-2738
Mailing Address - Fax:
Practice Address - Street 1:3246 CAHUENGA BLVD W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1302
Practice Address - Country:US
Practice Address - Phone:818-731-2738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASABLANCA OUTPATIENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility