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General NPI Number Information
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NPI Number | 1558045518
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Entity Type | Organization
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Legal Business Name | OCEANS LUXURY REHAB
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 147 EL LEVANTE
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3138
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Country | US
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Telephone | 949-899-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 AVENIDA PICO STE 268
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6957
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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 | OWNER
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Name | JACKIE BAHU
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Credential |
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Telephone | 949-899-7750
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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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