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General NPI Number Information
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NPI Number | 1578945440
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Entity Type | Organization
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Legal Business Name | GLORIOSA MANAGEMENT LLC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 25466 GLORIOSA DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4642
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Country | US
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Telephone | 951-427-4807
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Fax |
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Provider Business Mailing Address
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Address Line | 28202 CABOT RD 300
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-1222
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Country | US
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Telephone | 951-427-4807
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR AND DIRECTOR
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Name | MR. NICHLOAS RUSSI
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Credential | LAADC,NCAC,CCS
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Telephone | 951-427-4807
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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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