Healthcare Provider Details

I. General information

NPI: 1639768914
Provider Name (Legal Business Name): BEWELL ORANGE COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27130A PASEO ESPADA STE 1423
SAN JUAN CAPISTRANO CA
92675-2717
US

IV. Provider business mailing address

1953 SAN ELIJO AVE STE 203
CARDIFF BY THE SEA CA
92007-2348
US

V. Phone/Fax

Practice location:
  • Phone: 949-529-5945
  • Fax: 949-529-5946
Mailing address:
  • Phone: 302-636-5401
  • 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: KATHLEEN BIGSBY
Title or Position: CEO
Credential:
Phone: 310-751-4330