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General NPI Number Information
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NPI Number | 1750732483
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Entity Type | Organization
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Legal Business Name | PEPPERTREE MANAGEMENT, LLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 25352 HILLARY LN
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5217
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Country | US
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Telephone | 714-404-1273
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 AVENIDA PICO # C-474
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6957
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Country | US
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Telephone | 949-412-1900
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMEBER
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Name | MRS. JULIE GIBSON
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Credential |
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Telephone | 949-412-1900
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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 | 300639AP
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License Number State | CA
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