| NPI | 1104330364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYLE MACKELVEY Supervisor 714-948-6086 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 300315EP) |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2019-10-28 |