| NPI | 1962880914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRYLE MACKELVEY Supervisor 949-430-2874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 300315AP) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2015-05-11 |