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General NPI Number Information
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NPI Number | 1194250258
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Entity Type | Organization
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Legal Business Name | EXPERIENCE RECOVERY DETOX & RESIDENTIAL LLC.
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 3919 W HAZARD AVE
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City | SANTA ANA
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State | CA
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Zip | 92703-2625
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Country | US
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Telephone | 714-713-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 3919 W HAZARD AVE
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City | SANTA ANA
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State | CA
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Zip | 92703-2625
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Country | US
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Telephone | 800-870-3973
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Fax | 855-275-5428
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Authorized Official
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Title or Position | CEO
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Name | PHU NGUYEN
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Credential |
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Telephone | 714-951-8514
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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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