Healthcare Provider Details

I. General information

NPI: 1285568642
Provider Name (Legal Business Name): DETOX CALIFORNIA AT LAGUNA BEACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 COAST VIEW DR
LAGUNA BEACH CA
92651-2616
US

IV. Provider business mailing address

2942 CENTURY PL # 716
COSTA MESA CA
92626-4324
US

V. Phone/Fax

Practice location:
  • Phone: 805-512-1694
  • Fax:
Mailing address:
  • Phone: 949-693-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRIS BRINEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-512-1694