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General NPI Number Information
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NPI Number | 1881072304
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Entity Type | Organization
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Legal Business Name | KOOL LIVING, INC.
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Dates
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Enumeration Date | 05/16/2015
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 4014 CALLE BIENVENIDOS
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-2610
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Country | US
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Telephone | 951-427-4807
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Fax |
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Provider Business Mailing Address
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Address Line | 20138 ELKWOOD ST
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City | WINNETKA
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State | CA
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Zip | 91306-2312
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Country | US
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Telephone | 951-427-4807
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NICHOLAS RUSSI
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Credential |
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Telephone | 951-427-4807
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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 | 300332BP
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License Number State | CA
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