Healthcare Provider Details

I. General information

NPI: 1730758491
Provider Name (Legal Business Name): JJLT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 HUMMINGBIRD DR
COSTA MESA CA
92626-4833
US

IV. Provider business mailing address

5201 CONGRESS AVE STE 275
BOCA RATON FL
33487-3609
US

V. Phone/Fax

Practice location:
  • Phone: 949-467-4324
  • Fax:
Mailing address:
  • Phone: 949-467-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: COLIN MCBRIDE
Title or Position: CRO
Credential:
Phone: 631-672-7441