Organization
A WILDWOOD RECOVERY IOP
Active
Parent organization
A WILDWOOD RECOVERY
Organization subpart
Yes
Provider details
NPI number
Legal business name
A WILDWOOD RECOVERY
Authorized official
MS. SHANNON SIAOTONG (FACILITY ADMINISTRATOR)
(805) 493-5741
Entity
Organization
Contact information
Practice address
166 N. MOORPARK RD, SUITE 304, THOUSAND OAKS, CA 91360
(805) 497-1900
(805) 497-1920
Mailing address
166 N. MOORPARK RD, SUITE 304, THOUSAND OAKS, CA 91360
(805) 497-1900
(805) 497-1920
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
560040BP
CA
Other
Enumeration date
07/19/2018
Last updated
07/19/2018
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