Organization · NPI-2

12 South LLC

Substance Abuse Rehabilitation Facility · Lake Forest, CA

NPI number1154789766

StatusActive

Last updated in NPPESNov 2, 2022

Details

NPI: 1154789766
Entity type: Organization (NPI-2)
Legal business name: 12 South LLC
Organization subpart: No
Enumeration date: Feb 10, 2016
Certification date: Nov 2, 2022
Last updated: Nov 2, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
324500000X	Substance Abuse Rehabilitation Facility	–	–	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–
106H00000X	Marriage & Family Therapist	–	–

Other names

12 South Recovery (Other Name)

Practice location

23712 Birtcher Drive
Lake Forest, CA 92630

Phone 888-830-8374 · Fax 949-215-6650

Mailing address

23712 Birtcher Drive
Lake Forest, CA 92630

Phone 714-579-9304 · Fax 949-215-6650

Authorized official

Kyle Smith
Ceo/Owner
8888308374

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