Organization · NPI-2

Beachside Recovery Center LLC

Substance Abuse Rehabilitation Facility · Mission Viejo, CA

NPI number1104330364
StatusActive
Last updated in NPPESOct 28, 2019

Details

NPI
1104330364
Entity type
Organization (NPI-2)
Legal business name
Beachside Recovery Center LLC
Organization subpart
Yes
Enumeration date
Nov 27, 2017
Last updated
Oct 28, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
324500000X Substance Abuse Rehabilitation Facility300315EPCAYes

Practice location

23671 Brasilia St
Mission Viejo, CA 92691-3047

Phone 949-393-4070

Mailing address

Po Box 511330
Los Angeles, CA 90051-7885

Authorized official

Darryle Mackelvey
Supervisor
7149486086

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