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General NPI Number Information
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NPI Number | 1437853835
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Entity Type | Organization
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Legal Business Name | SEA CHANGE RECOVERY 2 LLC
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 2205 HILL ST
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City | SANTA MONICA
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State | CA
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Zip | 90405-5007
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Country | US
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Telephone | 949-244-5481
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Fax |
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Provider Business Mailing Address
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Address Line | 2973 HARBOR BLVD # 140
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City | COSTA MESA
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State | CA
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Zip | 92626-3912
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Country | US
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Telephone | 949-244-5481
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE
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Name | ANGELA MCMAHON
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Credential |
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Telephone | 619-871-7345
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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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Taxonomy #2
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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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