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General NPI Number Information
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NPI Number | 1124455738
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA ALCOHOL AND DRUG RECOVERY FOUNDATION
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 25332 PACIFICA AVE
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City | MISSION VIEJO
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State | CA
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Zip | 92691-3843
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Country | US
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Telephone | 714-319-7899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3453
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City | COSTA MESA
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State | CA
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Zip | 92628-3453
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Country | US
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Telephone | 714-319-7899
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEVIN C YARTER
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Credential |
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Telephone | 714-319-7899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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