Provider Demographics
NPI:1912653155
Name:CHANNEL ISLANDS REHAB, LLC
Entity type:Organization
Organization Name:CHANNEL ISLANDS REHAB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-934-8999
Mailing Address - Street 1:4744 TELEPHONE RD STE 3-248
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5244
Mailing Address - Country:US
Mailing Address - Phone:214-934-8999
Mailing Address - Fax:805-834-0288
Practice Address - Street 1:4474 MARKET ST STE 505
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5812
Practice Address - Country:US
Practice Address - Phone:805-218-0079
Practice Address - Fax:805-834-0288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANNEL ISLANDS REHAB, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility