Healthcare Provider Details

I. General information

NPI: 1376923151
Provider Name (Legal Business Name): WAVELENGTHS RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 CALIFORNIA ST
HUNTINGTON BEACH CA
92648-4715
US

IV. Provider business mailing address

703 CALIFORNIA ST
HUNTINGTON BEACH CA
92648-4715
US

V. Phone/Fax

Practice location:
  • Phone: 714-312-1011
  • Fax: 949-629-6833
Mailing address:
  • Phone: 714-312-1011
  • Fax: 949-629-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300323AP
License Number StateCA

VIII. Authorized Official

Name: WARREN BOYD
Title or Position: CEO
Credential:
Phone: 714-642-2404