MEDICARE: LAGUNA BEACH RECOVERY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300828AP	OTHER	CA	DHCS

General Provider Information

NPI Number	:	1184571119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA BEACH RECOVERY LLC

Provider Business Mailing Address
First Line	:	668 N COAST HWY # 213
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-1513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	866 COAST VIEW DR
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2618
Country	:	US
Telephone Number	:	949-696-3432
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE
Name	:	BRANDON HILGER
Credential	:
Telephone Number	:	949-333-9340

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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