MEDICARE: JRW GROUP 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1265923817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRW GROUP LLC

Provider Business Mailing Address
First Line	:	2900 BRISTOL ST STE E103
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-7906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25401 CABOT RD STE 114
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5530
Country	:	US
Telephone Number	:	714-540-9070
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. DAVID WELCH
Credential	:	PHD
Telephone Number	:	714-540-9070

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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