| NPI | 1013555069 |
|---|---|
| Doing Business As | DESTINATIONS FOR TEENS |
| Entity Type | Organization |
| Authorized Contact | DANIEL A SAMSON Owner/President 818-737-2221 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2024-01-18 |