MEDICARE: FOUR FORTY-NINE, INC.

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
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1932473329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR FORTY-NINE, INC.

Provider Business Mailing Address
First Line	:	26010 ACERO STE 100
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6720
Country	:	US
Telephone Number	:	855-435-7449
Fax Number	:	949-429-0767

Provider Business Practice Location Address
First Line	:	26010 ACERO STE 100
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2768
Country	:	US
Telephone Number	:	909-379-9237
Fax Number	:	949-429-0767

Authorized Official
Title or Position	:	OWNER-COO-PROGRAM ADMINISTRATOR
Name	:	MRS. CATHERINE TASSONE
Credential	:
Telephone Number	:	949-441-5949

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	08/04/2023

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