Provider Demographics
NPI:1992456255
Name:CMR REHAB CENTER OF SHERMAN OAKS, LLC
Entity type:Organization
Organization Name:CMR REHAB CENTER OF SHERMAN OAKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-761-9659
Mailing Address - Street 1:15303 VENTURA BLVD # 900-3
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3110
Mailing Address - Country:US
Mailing Address - Phone:747-332-5800
Mailing Address - Fax:
Practice Address - Street 1:15303 VENTURA BLVD # 900-3
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3110
Practice Address - Country:US
Practice Address - Phone:747-332-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESCENT MOON RECOVERY- ORANGE COUNTY IOP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility