MEDICARE: LAGUNA SHORES BEHAVIORAL HEALTH

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	:	1801385620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA SHORES BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	24662 EL CAMINO CAPISTRANO
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-3012
Country	:	US
Telephone Number	:	949-945-3585
Fax Number	:

Provider Business Practice Location Address
First Line	:	24662 EL CAMINO CAPISTRANO
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-3012
Country	:	US
Telephone Number	:	949-945-3585
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KATHERINE ANN SORENSEN
Credential	:
Telephone Number	:	949-945-3585

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	07/11/2023

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