Healthcare Provider Details

I. General information

NPI: 1386159945
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA RECOVERY CENTERS OCEANSIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 PIO PICO DR STE A-D
CARLSBAD CA
92008-1554
US

IV. Provider business mailing address

2850 PIO PICO DR STE A-D
CARLSBAD CA
92008-1554
US

V. Phone/Fax

Practice location:
  • Phone: 760-517-1758
  • Fax: 949-542-3878
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number370158AP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS PENNY
Title or Position: MANAGER
Credential:
Phone: 949-481-6156