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General NPI Number Information
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NPI Number | 1770912933
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Entity Type | Organization
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Legal Business Name | CASA BELLA RECOVERY
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 31365 MONTEREY ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6946
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Country | US
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Telephone | 949-715-0467
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Fax | 866-703-9903
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Provider Business Mailing Address
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Address Line | 31365 MONTEREY ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6946
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Country | US
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Telephone | 949-715-0467
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Fax | 866-703-9903
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Authorized Official
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Title or Position | CEO
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Name | STEVEN LOMONACO
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Credential |
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Telephone | 949-275-7581
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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 | 300222AP
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License Number State | CA
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