Healthcare Provider Details

I. General information

NPI: 1710241989
Provider Name (Legal Business Name): KEY 2 BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 TECHNOLOGY SUITE 173
IRVINE CA
92618-2725
US

IV. Provider business mailing address

16 TECHNOLOGY DR SUITE 173
IRVINE CA
92618-2355
US

V. Phone/Fax

Practice location:
  • Phone: 949-521-6890
  • Fax:
Mailing address:
  • Phone: 949-521-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberA7131111
License Number StateCA

VIII. Authorized Official

Name: MICHELE LAVIGNE
Title or Position: FOUNDER/PROGRAM DIRECTOR
Credential: CADCII
Phone: 949-521-6890