Provider Demographics
NPI:1215234455
Name:PROMINENCE CORPORATION
Entity type:Organization
Organization Name:PROMINENCE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-878-6900
Mailing Address - Street 1:4505 LAS VIRGENES RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1956
Mailing Address - Country:US
Mailing Address - Phone:818-878-6900
Mailing Address - Fax:818-878-6902
Practice Address - Street 1:2150 COLD CANYON RD
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2306
Practice Address - Country:US
Practice Address - Phone:818-878-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190722AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility