SOBER STAGES INC. OUTPATIENT PROGRAM (NPI# 1497178966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497178966 |
Entity Type | Organization |
Organization Name | SOBER STAGES INC. OUTPATIENT PROGRAM |
Practice Address |
19562 Ventura Blvd Suite 233 Tarzana CA 91356-2955 |
Practice Telephone | 3107095128 |
Mailing Telephone | 3107095128 |
Enumeration Date | 2014-02-03 |
Last Update Date | 2014-10-20 |
Authorized Official Name | DR. SARA BIVANS (EXECUTIVE DIRECTOR) |
Authorized Official Telephone | 3107095128 |
Authorized Official Credential | PHD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
LR1170411 | CA | Ambulatory Health Care Facilities |
Street Address |
19562 VENTURA BLVD SUITE 233 |
City | TARZANA |
State | CA |
Zip Code | 91356-2955 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1831328400 | Matrix Health Promotion | Home Health | 19562 Ventura Blvd, Ste 225, Tarzana, CA 91356-2955 | 2009-07-04 |
1508289174 | Sara Bivans | Psychologist | 19562 Ventura Blvd, Suite 233, Tarzana, CA 91356-2955 | 2014-02-01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679137293 | Sarah Badreau | Behavior Technician | 5554 Reseda Blv., Tarzana, CA 91356 | 2019-04-29 |
1831661966 | Daraie Dental Group Inc | Dentist | 5620 Wilbur Avenue Ste 300, Tarzana, CA 91356 | 2018-12-31 |
1982182770 | Blanca Garay | Respiratory Therapist, Registered | 18214 Burbank Blvd Apt 120, Tarzana, CA 91356 | 2018-08-02 |
1437659000 | Chloe Kang | Speech-Language Pathologist | 19019 Ventura Blvd., Tarzana, CA 91356 | 2018-02-20 |
1114430139 | Avb & Lv Corporation | Home Health | 18340 Ventura Blvd Ste 220, Tarzana, CA 91356 | 2017-11-13 |
1881110468 | Samina Qadir | Registered Nurse | 18321 Clark St., Tarzana, CA 91356 | 2017-08-16 |
1700306776 | Debbie Rehman Lux | Marriage & Family Therapist | 18370 Burbank Blvd., Suite 211, Tarzana, CA 91356 | 2017-06-21 |
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1669906020 | Evolve Growth Initiatives LLC | Clinic/Center | 5435 Aura Avenue, Tarzana, CA 91356 | 2017-04-12 |
1780130088 | Evolve Growth Initiatives, LLC | Clinic/Center | 5358 Vanalden Drive, Tarzana, CA 91356 | 2016-08-28 |
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Taxonomy Code | 261QR0405X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Rehabilitation, Substance Use Disorder |
Definition to come... |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.