Healthcare Provider Details

I. General information

NPI: 1134784085
Provider Name (Legal Business Name): WINDSTONE ADDICTION CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320B N WILSHIRE AVE
ANAHEIM CA
92801-5825
US

IV. Provider business mailing address

151 KALMUS DR STE K1
COSTA MESA CA
92626-5975
US

V. Phone/Fax

Practice location:
  • Phone: 714-833-5604
  • Fax: 714-833-5038
Mailing address:
  • Phone: 714-384-3339
  • Fax: 714-384-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH ANNE WINN
Title or Position: ADMIN
Credential:
Phone: 714-384-3339