Healthcare Provider Details

I. General information

NPI: 1689764565
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ALCOHOL & DRUG PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 PLACENTIA AVE
COSTA MESA CA
92627-7500
US

IV. Provider business mailing address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-2271
  • Fax: 949-646-1211
Mailing address:
  • Phone: 562-923-4545
  • Fax: 562-862-0918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number300054AN
License Number StateCA

VIII. Authorized Official

Name: MS. LYNNE APPEL
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.
Phone: 562-923-4545