Healthcare Provider Details

I. General information

NPI: 1932473329
Provider Name (Legal Business Name): FOUR FORTY-NINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26010 ACERO STE 100
MISSION VIEJO CA
92691-2768
US

IV. Provider business mailing address

26010 ACERO STE 100
MISSION VIEJO CA
92691-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-379-9237
  • Fax: 949-429-0767
Mailing address:
  • Phone: 855-435-7449
  • Fax: 949-429-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE TASSONE
Title or Position: OWNER-COO-PROGRAM ADMINISTRATOR
Credential:
Phone: 949-441-5949