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General NPI Number Information
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NPI Number | 1043397466
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Entity Type | Organization
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Legal Business Name | THE MAINSTREAM GROUP, INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 AVENIDA SERRA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4760
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Country | US
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Telephone | 949-366-9210
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Fax | 949-498-5706
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Provider Business Mailing Address
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Address Line | 101 AVENIDA SERRA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4760
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Country | US
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Telephone | 949-366-9210
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Fax | 949-498-5706
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RICHARD G COLE
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Credential |
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Telephone | 949-366-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300084IN
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License Number State | CA
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