Organization
PACIFIC TEEN TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY MANNE (CEO)
(917) 662-7192
Entity
Organization
Contact information
Practice address
29053 PACIFIC COAST HWY, MALIBU, CA 90265-3948
(917) 662-7192
Mailing address
29053 PACIFIC COAST HWY, MALIBU, CA 90265-3948
(917) 662-7192
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
10/08/2018
Last updated
10/08/2018
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