Healthcare Provider Details

I. General information

NPI: 1730915695
Provider Name (Legal Business Name): CALIFORNIA DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17841 LINCOLN ST
VILLA PARK CA
92861-6370
US

IV. Provider business mailing address

2549 EASTBLUFF DR STE 726
NEWPORT BEACH CA
92660-3500
US

V. Phone/Fax

Practice location:
  • Phone: 949-742-0172
  • Fax:
Mailing address:
  • Phone: 949-742-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: REESE A MORGAN
Title or Position: CEO
Credential:
Phone: 949-742-0172