Healthcare Provider Details

I. General information

NPI: 1982940383
Provider Name (Legal Business Name): MONROE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 E 17TH ST SUITE 200
COSTA MESA CA
92627-3265
US

IV. Provider business mailing address

811 N RANCH WOOD TRL
ORANGE CA
92869-2305
US

V. Phone/Fax

Practice location:
  • Phone: 877-628-3367
  • Fax: 949-612-0236
Mailing address:
  • Phone: 877-628-3367
  • Fax: 949-612-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number300233CP
License Number StateCA

VIII. Authorized Official

Name: MR. JAMISON MONROE JR.
Title or Position: CEO
Credential:
Phone: 877-628-3367