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General NPI Number Information
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NPI Number | 1952174849
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Entity Type | Organization
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Legal Business Name | DANA SHORES RECOVERY
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 30971 SILVER LEAF DR
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2952
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Country | US
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Telephone | 909-213-8504
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Fax |
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Provider Business Mailing Address
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Address Line | 30971 SILVER LEAF DR
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2952
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Country | US
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Telephone | 909-213-8504
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHARLES HOHMAN
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Credential |
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Telephone | 949-503-1705
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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 |
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License Number State |
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