MEDICARE: NORTH STAR TREATMENT 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

General Provider Information

NPI Number	:	1760221055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR TREATMENT LLC

Provider Business Mailing Address
First Line	:	28202 CABOT RD STE 505
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-1271
Country	:	US
Telephone Number	:	949-683-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	27772 CAMINO LAS RAMBLAS
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-5219
Country	:	US
Telephone Number	:	949-683-8721
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT LEIGH
Credential	:
Telephone Number	:	949-683-8721

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/24/2024

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