MEDICARE: SOUTHWEST ADDICTION CENTERS 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982547972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ADDICTION CENTERS LLC

Provider Business Mailing Address
First Line	:	412 OLIVE AVE STE 533
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-5142
Country	:	US
Telephone Number	:	323-670-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 ALAMO AVE SE STE 314
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-3523
Country	:	US
Telephone Number	:	323-670-1111
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PRISCILLA MONIQUE PORTILLO
Credential	:
Telephone Number	:	323-670-1111

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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