Organization · NPI-2

417 Orange County LLC

Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children · Mission Viejo, CA

NPI number1649047242
StatusActive
Last updated in NPPESDec 6, 2023

Details

NPI
1649047242
Entity type
Organization (NPI-2)
Legal business name
417 Orange County LLC
Organization subpart
No
Enumeration date
Dec 5, 2023
Certification date
Dec 6, 2023
Last updated
Dec 6, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children––Yes
251S00000X Community/Behavioral Health––
261QM0855X Clinic/Center, Adolescent and Children Mental Health––

Other names

  • 417 Recovery (Doing Business As)

Practice location

26010 Acero Ste 200
Mission Viejo, CA 92691-2768

Phone 760-485-6563

Mailing address

1595 Grand Ave Ste 102
San Marcos, CA 92078-2450

Phone 760-485-6563

Authorized official

Stevie Kuhn
Cfo
7604856563

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