Healthcare Provider Details

I. General information

NPI: 1316462575
Provider Name (Legal Business Name): BEACH CITY TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30461 PUERTO VALLARTA DR
LAGUNA NIGUEL CA
92677-2480
US

IV. Provider business mailing address

421 11TH ST
HUNTINGTON BEACH CA
92648-4507
US

V. Phone/Fax

Practice location:
  • Phone: 714-726-8652
  • Fax:
Mailing address:
  • Phone: 714-726-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300654BP
License Number StateCA

VIII. Authorized Official

Name: JOSHUA BEAUCHAINE
Title or Position: OWNER
Credential:
Phone: 949-584-5957