Healthcare Provider Details

I. General information

NPI: 1386581064
Provider Name (Legal Business Name): SOCAL EMPOWERED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23712 AVENIDA COLUMBIA
MISSION VIEJO CA
92691-3413
US

IV. Provider business mailing address

22602 COSTA BELLA DR
LAKE FOREST CA
92630-4218
US

V. Phone/Fax

Practice location:
  • Phone: 949-701-3551
  • Fax:
Mailing address:
  • Phone: 949-701-3551
  • Fax: 888-846-8569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES PERRAIE
Title or Position: MANAGING MEMBER
Credential:
Phone: 949-701-3551