MEDICARE: AFFINITY GROUP, LLC.

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
1	324500000X	Substance Abuse Rehabilitation Facility	300330AP	CA

General Provider Information

NPI Number	:	1639546583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY GROUP, LLC.

Provider Business Mailing Address
First Line	:	18201 VON KARMAN AVE
Second Line	:	SUITE 330
City	:	IRVINE
State	:	CA
Zip	:	92612-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31952 PASEO TERRAZA
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-3026
Country	:	US
Telephone Number	:	714-722-0112
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EVAN RABINOWITZ
Credential	:
Telephone Number	:	714-722-0112

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	08/26/2015

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