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General NPI Number Information
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NPI Number | 1538991625
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Entity Type | Organization
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Legal Business Name | KNOX RECOVERY LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 1217 W ALTON AVE
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City | SANTA ANA
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State | CA
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Zip | 92707-3871
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Country | US
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Telephone | 949-244-2279
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Fax |
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Provider Business Mailing Address
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Address Line | 27181 ASHTON CIR
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City | LAKE FOREST
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State | CA
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Zip | 92630-5802
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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 | DIRECTOR
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Name | NICHOLAS BEETS
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Credential |
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Telephone | 949-933-1931
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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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