Organization · NPI-2

417 San Clemente, LLC

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

NPI number1770968513
StatusActive
Last updated in NPPESJul 2, 2019

Details

NPI
1770968513
Entity type
Organization (NPI-2)
Legal business name
417 San Clemente, LLC
Organization subpart
No
Enumeration date
Jul 22, 2015
Last updated
Jul 2, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children––Yes
251S00000X Community/Behavioral Health––

Practice location

26010 Acero Ste 200
Mission Viejo, CA 92691-6716

Phone 949-525-7977

Mailing address

26010 Acero Ste 200
Mission Viejo, CA 92691-6716

Phone 949-525-7977

Authorized official

Scott Christian Kalland
Owner/President
9495257977

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