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General NPI Number Information
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NPI Number | 1023403037
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Entity Type | Organization
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Legal Business Name | FAITH BY THE SEA, INC.
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 27129 CALLE ARROYO SUITE 1821
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2764
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Country | US
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Telephone | 949-542-8480
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Fax | 949-429-3698
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Provider Business Mailing Address
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Address Line | 26895 ALISO CREEK RD SUITE B-773
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5301
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Country | US
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Telephone | 949-542-8480
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Fax | 949-429-3698
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RICHARD ZONA III
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Credential |
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Telephone | 949-542-8480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 300309AP
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License Number State | CA
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