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General NPI Number Information
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NPI Number | 1275069684
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Entity Type | Organization
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Legal Business Name | MISSION REHAB, LLC.
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Dates
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Enumeration Date | 05/04/2017
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 32656 GOLDEN LANTERN SUITE B #473
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City | DANA POINT
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State | CA
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Zip | 92629
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Country | US
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Telephone | 949-750-9777
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Fax | 480-383-6983
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Provider Business Mailing Address
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Address Line | 32656 STREETS OF THE GOLDEN LANTERN SUITE B #47
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City | DANA POINT
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State | CA
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Zip | 92621
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Country | US
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Telephone | 949-750-9777
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | MR. DANIEL L CASE SR.
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Credential |
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Telephone | 949-750-9777
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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 | CA
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