MEDICARE: OCEANFRONT RECOVERY

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	:	1255983086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEANFRONT RECOVERY

Provider Business Mailing Address
First Line	:	312 BROADWAY ST STE 202
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-4331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 ZELL DR
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2047
Country	:	US
Telephone Number	:	877-279-1777
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF QUALITY AND COMPLIANCE
Name	:	ANNA PIEPENBRING
Credential	:
Telephone Number	:	949-777-4758

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	02/21/2020

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Directions to “OCEANFRONT RECOVERY ” Practice Location

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