Provider Demographics
NPI:1306354634
Name:SEA CHANGE SANTA MONICA, LP
Entity type:Organization
Organization Name:SEA CHANGE SANTA MONICA, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXXIS
Authorized Official - Middle Name:KYLA
Authorized Official - Last Name:AMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-330-0396
Mailing Address - Street 1:1831 WILSHIRE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5778
Mailing Address - Country:US
Mailing Address - Phone:424-330-0396
Mailing Address - Fax:323-843-9800
Practice Address - Street 1:1807 PIER AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5947
Practice Address - Country:US
Practice Address - Phone:888-823-3310
Practice Address - Fax:323-843-9800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEA CHANGE SANTA MONICA, L.P.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-22
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190831CP324500000X
CA190831AP261QR0401X
324500000X
CA190831BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)