Healthcare Provider Details

I. General information

NPI: 1548727464
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ADDICTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35200 LINDA ROSEA RD
TEMECULA CA
92592-9531
US

IV. Provider business mailing address

2755 BRISTOL ST STE 140
COSTA MESA CA
92626-5985
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-5081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMILY LUSSIER
Title or Position: SENIOR CORP. DIRECTOR
Credential:
Phone: 714-619-5081