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General NPI Number Information
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NPI Number | 1194056358
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Entity Type | Organization
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Legal Business Name | PUR DETOX INC
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 25071 ALICIA DR
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City | DANA POINT
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State | CA
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Zip | 92629-2413
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Country | US
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Telephone | 888-803-3869
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Fax |
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Provider Business Mailing Address
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Address Line | 751 S RIDGEVIEW RD
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City | ANAHEIM
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State | CA
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Zip | 92807-4810
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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 | INSURANCE OFFICER
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Name | MRS. HOLLAND BINFORD
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Credential |
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Telephone | 888-853-3869
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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 | 300198AP
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License Number State | CA
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