MEDICARE: BEWELL ORANGE COUNTY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1164141255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEWELL ORANGE COUNTY LLC

Provider Business Mailing Address
First Line	:	27130 PASEO ESPADA STE A1423
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-6712
Country	:	US
Telephone Number	:	949-529-5945
Fax Number	:

Provider Business Practice Location Address
First Line	:	31222 BELFORD DR
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1833
Country	:	US
Telephone Number	:	949-529-5945
Fax Number	:

Authorized Official
Title or Position	:	VP REVENUE CYCLE
Name	:	BROOKE ZIMMERMAN
Credential	:
Telephone Number	:	217-649-5309

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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Directions to “BEWELL ORANGE COUNTY LLC ” Practice Location

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