Provider Demographics
NPI:1447826151
Name:ABC AMERICAN BEHAVIORAL TREATMENT CENTER
Entity type:Organization
Organization Name:ABC AMERICAN BEHAVIORAL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYUKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-319-2144
Mailing Address - Street 1:2590 E MAIN ST UNIT 105
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2619
Mailing Address - Country:US
Mailing Address - Phone:818-319-2144
Mailing Address - Fax:
Practice Address - Street 1:2590 E MAIN ST UNIT 105
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2619
Practice Address - Country:US
Practice Address - Phone:818-319-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health