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General NPI Number Information
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NPI Number | 1235599879
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Entity Type | Organization
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Legal Business Name | CREST RECOVERY LLC
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 29522 VIA VALVERDE
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-1868
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Country | US
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Telephone | 949-283-4679
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Fax |
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Provider Business Mailing Address
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Address Line | 45 TIMBERLAND
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2108
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Country | US
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Telephone | 949-283-4679
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Fax |
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | CEAIRA COFFIN
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Credential |
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Telephone | 833-233-0091
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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 | 300351AP
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License Number State | CA
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