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General NPI Number Information
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NPI Number | 1639987316
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Entity Type | Organization
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Legal Business Name | STILL WATERS RECOVERY CENTER
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Dates
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Enumeration Date | 12/26/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 20422 BEACH BLVD STE 235
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-4398
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Country | US
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Telephone | 714-202-9818
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Fax |
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Provider Business Mailing Address
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Address Line | 20422 BEACH BLVD STE 235
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-4398
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Country | US
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Telephone | 714-202-9818
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | RUDOLPH SWIGART
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Credential |
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Telephone | 714-200-4185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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