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General NPI Number Information
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NPI Number | 1124766233
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Entity Type | Organization
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Legal Business Name | CAPISTRANO BEACH RECOVERY CENTER LLC
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 27391 SILVER CREEK DR
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1525
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Country | US
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Telephone | 93-429-4306
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Fax |
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Provider Business Mailing Address
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Address Line | 27391 SILVER CREEK DR
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1525
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Country | US
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Telephone | 93-429-4306
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ROBERT LEIGH
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Credential |
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Telephone | 949-683-8721
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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 |
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License Number State |
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