Provider Demographics
NPI:1154817203
Name:TRUE NORTH DETOX LLC
Entity Type:Organization
Organization Name:TRUE NORTH DETOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BEAUCHAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-584-5957
Mailing Address - Street 1:27525 PUERTA REAL STE 100-316
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6379
Mailing Address - Country:US
Mailing Address - Phone:844-244-7837
Mailing Address - Fax:
Practice Address - Street 1:21877 OAK HILL LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9346
Practice Address - Country:US
Practice Address - Phone:844-244-7837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100094AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility