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General NPI Number Information
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NPI Number | 1295129112
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Entity Type | Organization
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Legal Business Name | KOOL LIVING INC.
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Dates
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Enumeration Date | 03/28/2015
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 26421 CROWN VALLEY PKWY SUITE 200
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8564
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Country | US
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Telephone | 866-921-3778
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Fax |
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Provider Business Mailing Address
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Address Line | 20138 ELKWOOD ST
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City | WINNETKA
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State | CA
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Zip | 91306-2312
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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 | VICE-PRESIDENT
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Name | NICHOLAS RUSSI
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Credential | LAADC CCS
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Telephone | 951-427-4807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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