MEDICARE: RESURGENCE CALIFORNIA, 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	:	1295487833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURGENCE CALIFORNIA, LLC

Provider Business Mailing Address
First Line	:	3151 AIRWAY AVE STE E1
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-4620
Country	:	US
Telephone Number	:	828-773-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 W BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1091
Country	:	US
Telephone Number	:	702-305-9167
Fax Number	:

Authorized Official
Title or Position	:	VP OF COMPLIANCE
Name	:	CAMILLE LINARES
Credential	:
Telephone Number	:	888-700-5053

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	11/09/2022

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