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General NPI Number Information
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NPI Number | 1851052062
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Entity Type | Organization
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Legal Business Name | SOCAL EMPOWERED, LLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 23671 BRASILIA ST
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City | MISSION VIEJO
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State | CA
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Zip | 92691-3047
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Country | US
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Telephone | 888-846-8569
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Fax |
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Provider Business Mailing Address
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Address Line | 22602 COSTA BELLA DR
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City | LAKE FOREST
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State | CA
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Zip | 92630-4218
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Country | US
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Telephone | 888-846-8569
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JAMES PERRAIE
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Credential |
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Telephone | 714-313-3841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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