Provider Demographics
NPI:1033576566
Name:BICOUR LLC
Entity Type:Organization
Organization Name:BICOUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CASE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:480-612-4297
Mailing Address - Street 1:35 S PEAK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2903
Mailing Address - Country:US
Mailing Address - Phone:480-612-4294
Mailing Address - Fax:480-383-6983
Practice Address - Street 1:35 S PEAK
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2903
Practice Address - Country:US
Practice Address - Phone:480-612-4294
Practice Address - Fax:480-383-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 3245S0500X
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children