Healthcare Provider Details

I. General information

NPI: 1942952593
Provider Name (Legal Business Name): CALIFORNIA CARE DETOX & TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27075 CABOT RD STE 109
LAGUNA HILLS CA
92653-7014
US

IV. Provider business mailing address

27068 LA PAZ RD # 649
ALISO VIEJO CA
92656-3041
US

V. Phone/Fax

Practice location:
  • Phone: 949-291-3333
  • Fax:
Mailing address:
  • Phone: 949-291-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON BOUQUET
Title or Position: CEO
Credential:
Phone: 949-291-3333