Healthcare Provider Details

I. General information

NPI: 1689298648
Provider Name (Legal Business Name): SUNSET BEACH RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5641 JANE ST
WESTMINSTER CA
92683-4166
US

IV. Provider business mailing address

5641 JANE ST
WESTMINSTER CA
92683-4166
US

V. Phone/Fax

Practice location:
  • Phone: 800-935-2305
  • 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 State

VIII. Authorized Official

Name: MICHAEL PRIESING
Title or Position: ADMINISTRATOR
Credential:
Phone: 800-935-2305