Provider Demographics
NPI:1063255255
Name:MOUNTAIN VIEW DETOX
Entity type:Organization
Organization Name:MOUNTAIN VIEW DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-445-5276
Mailing Address - Street 1:3606 LARIAT WAY
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1245
Mailing Address - Country:US
Mailing Address - Phone:747-966-7020
Mailing Address - Fax:
Practice Address - Street 1:3606 LARIAT WAY
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1245
Practice Address - Country:US
Practice Address - Phone:747-966-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility