Healthcare Provider Details

I. General information

NPI: 1982915807
Provider Name (Legal Business Name): ADELANTE RECOVERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MONTECITO DR
CORONA DEL MAR CA
92625-1017
US

IV. Provider business mailing address

PO BOX 604
CORONA DEL MAR CA
92625-0604
US

V. Phone/Fax

Practice location:
  • Phone: 949-887-4448
  • Fax: 949-706-9769
Mailing address:
  • Phone: 949-887-4448
  • Fax: 949-706-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300206AP
License Number StateCA

VIII. Authorized Official

Name: DAN BASKEY
Title or Position: MANAGER
Credential:
Phone: 949-887-4448