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NPI Code Detail

MEDICARE: FIRST HOUSE DETOX

MEDICARE: FIRST HOUSE DETOX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation FacilityG82171CA

General Provider Information

NPI Number : 1235423229
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST HOUSE DETOX
Provider Business Mailing Address
First Line : 1048 IRVINE AVE # 443
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-4602
Country : US
Telephone Number : 949-515-2360
Fax Number : 949-515-6278
Provider Business Practice Location Address
First Line : 1048 IRVINE AVE # 443
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-4602
Country : US
Telephone Number : 949-515-2360
Fax Number : 949-515-6278
Authorized Official
Title or Position : OWNER
Name : MR. LLOYD GORMAN
Credential :
Telephone Number : 949-515-6278
Provider Enumeration Date : 06/07/2011
Last Update Date : 06/07/2011

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Directions to “FIRST HOUSE DETOX ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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