Healthcare Provider Details

I. General information

NPI: 1144668468
Provider Name (Legal Business Name): A MISSION FOR MICHAEL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 06/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34270 PACIFIC COAST HWY STE N
DANA POINT CA
92629-2825
US

IV. Provider business mailing address

34270 PACIFIC COAST HWY STE N
DANA POINT CA
92629-2825
US

V. Phone/Fax

Practice location:
  • Phone: 949-489-0950
  • Fax:
Mailing address:
  • Phone: 949-489-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: JOHN SMITH III
Title or Position: EXECUTIVE DIRECTOR
Credential: J.D.
Phone: 714-392-7306