Healthcare Provider Details

I. General information

NPI: 1699543736
Provider Name (Legal Business Name): ESPRIT SUPPORTIVE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27725 SANTA MARGARITA PKWY STE 221
MISSION VIEJO CA
92691-6707
US

IV. Provider business mailing address

27725 SANTA MARGARITA PKWY STE 221
MISSION VIEJO CA
92691-6707
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATESHA KING
Title or Position: OFFICER
Credential:
Phone: 951-992-2665