Healthcare Provider Details

I. General information

NPI: 1821908955
Provider Name (Legal Business Name): LAGUNA BEACH RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 FOREST AVE STE 18
LAGUNA BEACH CA
92651-2133
US

IV. Provider business mailing address

384 FOREST AVE STE 18
LAGUNA BEACH CA
92651-2133
US

V. Phone/Fax

Practice location:
  • Phone: 949-696-3432
  • Fax:
Mailing address:
  • Phone: 949-696-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON HILGER
Title or Position: CMO
Credential:
Phone: 949-333-9340