Healthcare Provider Details

I. General information

NPI: 1215873724
Provider Name (Legal Business Name): WEST COAST DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 CLEVELAND WAY
CORONA CA
92881-5905
US

IV. Provider business mailing address

3225 BIGHORN CIR
CORONA CA
92881-8747
US

V. Phone/Fax

Practice location:
  • Phone: 866-758-2862
  • Fax:
Mailing address:
  • Phone: 866-758-2862
  • Fax:

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: BIANCA MLADINICH
Title or Position: CFO
Credential:
Phone: 714-341-7749