Healthcare Provider Details

I. General information

NPI: 1407346489
Provider Name (Legal Business Name): TRUE NORTH DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HERNDON AVE STE 102
CLOVIS CA
93611-6302
US

IV. Provider business mailing address

27525 PUERTA REAL STE 100-316
MISSION VIEJO CA
92691-6379
US

V. Phone/Fax

Practice location:
  • Phone: 844-244-7837
  • Fax:
Mailing address:
  • Phone: 844-244-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN BEAUCHAINE
Title or Position: COO
Credential:
Phone: 714-417-7628