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General NPI Number Information
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NPI Number | 1417739178
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Entity Type | Organization
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Legal Business Name | DETOX CALIFORNIA AT CLIFFSIDE CAPISTRANO INC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 35341 CAMINO CAPISTRANO
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City | DANA POINT
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State | CA
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Zip | 92624-1803
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Country | US
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Telephone | 312-315-3315
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 CENTURY PL # 716
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City | COSTA MESA
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State | CA
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Zip | 92626-4324
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Country | US
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Telephone | 805-512-1694
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE MANAGER
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Name | CHRIS BRINEY
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Credential |
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Telephone | 805-512-1694
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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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