Provider Demographics
NPI:1962867804
Name:PASSAGES BEVERLYWOOD LLC
Entity type:Organization
Organization Name:PASSAGES BEVERLYWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAX
Authorized Official - Middle Name:
Authorized Official - Last Name:PRENTISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-589-2880
Mailing Address - Street 1:6428 MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4492
Mailing Address - Country:US
Mailing Address - Phone:310-589-2880
Mailing Address - Fax:310-589-2858
Practice Address - Street 1:2370 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2029
Practice Address - Country:US
Practice Address - Phone:310-589-2880
Practice Address - Fax:310-589-2858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRASSHOPPER HOUSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder