Healthcare Provider Details

I. General information

NPI: 1316427446
Provider Name (Legal Business Name): EXPERIENCE RECOVERY DETOX & RESIDENTIAL LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 W HAZARD AVE
SANTA ANA CA
92703-2625
US

IV. Provider business mailing address

3919 W HAZARD AVE
SANTA ANA CA
92703-2625
US

V. Phone/Fax

Practice location:
  • Phone: 800-970-3973
  • Fax: 855-275-5428
Mailing address:
  • Phone: 800-870-3973
  • Fax: 855-275-5428

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: JAMES SEWELL
Title or Position: CEO, JDS CONSUTING, INC
Credential:
Phone: 402-250-8989