Healthcare Provider Details

I. General information

NPI: 1851691737
Provider Name (Legal Business Name): SEACLIFF RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18682 BEACH BLVD SUITE 255
HUNTINGTON BEACH CA
92648-5049
US

IV. Provider business mailing address

225 7TH ST UNIT 2
HUNTINGTON BEACH CA
92648-5049
US

V. Phone/Fax

Practice location:
  • Phone: 714-960-0078
  • Fax:
Mailing address:
  • Phone: 714-960-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number300152BP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRYL KAZUO FUJIHARA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-960-0078