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General NPI Number Information
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NPI Number | 1831968718
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Entity Type | Organization
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Legal Business Name | CALIFORNIA DETOX, LLC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 17811 BIGELOW PARK
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City | TUSTIN
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State | CA
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Zip | 92780-2110
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Country | US
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Telephone | 949-742-0172
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Fax |
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Provider Business Mailing Address
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Address Line | 2549 EASTBLUFF DR STE 726
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3500
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Country | US
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Telephone | 949-742-0172
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. REESE MORGAN
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Credential |
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Telephone | 949-742-0172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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