Healthcare Provider Details

I. General information

NPI: 1649745688
Provider Name (Legal Business Name): WINDWARD WAY RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 DOCTORS CIR UNIT A
COSTA MESA CA
92627-1969
US

IV. Provider business mailing address

3822 CAMPUS DR STE 500
NEWPORT BEACH CA
92660-2607
US

V. Phone/Fax

Practice location:
  • Phone: 657-304-0103
  • Fax:
Mailing address:
  • Phone:
  • 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: IAN ROY
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 657-304-0103