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General NPI Number Information
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NPI Number | 1164385225
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Entity Type | Organization
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Legal Business Name | CAPO COAST DETOX LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 31941 PASEO TERRAZA
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3025
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Country | US
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Telephone | 949-359-5669
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Fax |
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Provider Business Mailing Address
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Address Line | 21263 DOUBTFUL CANYON DR
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City | CYPRESS
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State | TX
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Zip | 77433-8470
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | MATTHEW LEE
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Credential |
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Telephone | 619-987-8078
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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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