=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710739248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTER BEHAVIORAL HEALTH CAPISTRANO BEACH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2024
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33452 VIA DE AGUA
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-4931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-298-2772
-----------------------------------------------------
Fax | 949-308-7789
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34270 PACIFIC COAST HWY STE C
-----------------------------------------------------
City | DANA POINT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92629-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-298-2772
-----------------------------------------------------
Fax | 949-308-7789
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MICHELLE DUENSING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-298-2772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------