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General NPI Number Information
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NPI Number | 1518320415
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Entity Type | Organization
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Legal Business Name | ADDICTION HEALTH ALLIANCE LLC
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 605 AVENIDA LAS FLORES
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City | SAN CLEMENTE
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State | CA
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Zip | 92672
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Country | US
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Telephone | 513-280-2714
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Fax |
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Provider Business Mailing Address
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Address Line | 34249 CAMINO CAPISTRANO
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City | CAPISTRANO BEACH
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State | CA
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Zip | 92624-1138
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Country | US
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Telephone | 949-481-6156
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. LINDSEY MYERS
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Credential |
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Telephone | 513-280-2714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 300314AP
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License Number State | CA
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