Healthcare Provider Details

I. General information

NPI: 1073340162
Provider Name (Legal Business Name): WAVELENGTHS MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W FL 17 SUITE 1710
ORANGE CA
92868-5905
US

IV. Provider business mailing address

333 CITY BLVD W FL 17 SUITE 1710
ORANGE CA
92868-5905
US

V. Phone/Fax

Practice location:
  • Phone: 714-642-2404
  • Fax:
Mailing address:
  • Phone: 714-642-2404
  • 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: WARREN BOYD
Title or Position: CEO
Credential:
Phone: 714-642-2404