1528303682 NPI number — RYLIST,INC

Table of content: (NPI 1528303682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528303682 NPI number — RYLIST,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYLIST,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LA VENTANA TREATMENT PROGRAMS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528303682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1408 E THOUSAND OAKS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91362-2889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-239-3552
Provider Business Mailing Address Fax Number:
805-777-9226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 N CONEJO SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-379-0565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ZAMARRPIA
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
818-584-5615

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  560038DP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 560038DP . This is a "ADP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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