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General NPI Number Information
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NPI Number | 1639546583
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Entity Type | Organization
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Legal Business Name | AFFINITY GROUP, LLC.
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 31952 PASEO TERRAZA
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3026
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Country | US
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Telephone | 714-722-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 18201 VON KARMAN AVE SUITE 330
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City | IRVINE
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State | CA
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Zip | 92612-1000
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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 | CEO
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Name | EVAN RABINOWITZ
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Credential |
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Telephone | 714-722-0112
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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 | 300330AP
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License Number State | CA
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