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General NPI Number Information
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NPI Number | 1679992853
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Entity Type | Organization
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Legal Business Name | PACIFIC PALMS RECOVERY, LLC.
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 3551 CAMINO MIRA COSTA STE T
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3504
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Country | US
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Telephone | 949-943-5188
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Fax | 949-542-8565
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Provider Business Mailing Address
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Address Line | 3551 CAMINO MIRA COSTA STE T
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3504
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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 | VP/CEO
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Name | AMY CHRISTLE
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Credential |
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Telephone | 949-943-5188
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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 | 300273AP
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License Number State | CA
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