Provider Demographics
NPI:1104380047
Name:OCEAN HILLS RECOVERY INC.
Entity Type:Organization
Organization Name:OCEAN HILLS RECOVERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-388-0112
Mailing Address - Street 1:27124 PASEO ESPADA STE 805
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6787
Mailing Address - Country:US
Mailing Address - Phone:949-388-0112
Mailing Address - Fax:949-388-4625
Practice Address - Street 1:34469 CAMINO EL MOLINO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92624-1070
Practice Address - Country:US
Practice Address - Phone:949-388-0112
Practice Address - Fax:949-388-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility