Healthcare Provider Details

I. General information

NPI: 1346614666
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ADDICTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 DE PORTOLA RD
TEMECULA CA
92592-7801
US

IV. Provider business mailing address

2755 BRISTOL STREET SUITE 140
COSTA MESA CA
92626
US

V. Phone/Fax

Practice location:
  • Phone: 951-302-2481
  • Fax:
Mailing address:
  • Phone: 714-619-5081
  • Fax: 206-426-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. AARON BROWER
Title or Position: PRESIDENT
Credential:
Phone: 714-619-5081