Provider Demographics
NPI:1124560297
Name:CAPO CANYON RECOVERY LLC
Entity Type:Organization
Organization Name:CAPO CANYON RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-259-3052
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92693-0448
Mailing Address - Country:US
Mailing Address - Phone:800-804-8714
Mailing Address - Fax:
Practice Address - Street 1:26991 EL CIERVO LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6018
Practice Address - Country:US
Practice Address - Phone:800-804-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300359AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility