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General NPI Number Information
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NPI Number | 1992384663
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Entity Type | Organization
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Legal Business Name | CRESCENT MOON RECOVERY, LLC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 11770 WARNER AVE STE 207
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2661
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Country | US
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Telephone | 714-464-8474
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Fax | 714-948-8883
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Provider Business Mailing Address
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Address Line | 11770 WARNER AVE STE 207
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2661
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Country | US
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Telephone | 714-464-8474
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Fax | 714-948-8883
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Authorized Official
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Title or Position | CEO
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Name | DR. ADAM WADE
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Credential | MD
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Telephone | 661-706-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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