WESTERN PACIFIC RE-HAB NPI 1881033777

NPI Information

NPI: 1881033777
Provider Name: WESTERN PACIFIC RE-HAB
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 05D2144598

Address:
9462 VAN NUYS BLVD
PANORAMA CITY, CA
ZIP 91402
Phone: (818) 891-8555
Get Directions

WESTERN PACIFIC RE-HAB is a methadone clinic center in Panorama City, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. WESTERN PACIFIC RE-HAB NPI is 1881033777. The provider is registered as an organization entity type.

The provider's business location address is:

9462 VAN NUYS BLVD
PANORAMA CITY, CA
ZIP 91402-310
Phone: (818) 891-8555

The provider's authorized official is Mark Hickman .
The authorized official title is Ceo and has the following contact phone number (818) 956-3737.

The CLIA number assigned to this NPI record is 05D2144598 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/24/2013 and was last updated on 1/23/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM2800X	Clinic/Center	Methadone	19-121	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7000	OTHER	CALIFORNIA	CALIFORNIA DRUG MEDI-CAL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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