Provider Demographics
NPI:1235423229
Name:FIRST HOUSE DETOX
Entity Type:Organization
Organization Name:FIRST HOUSE DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-515-6278
Mailing Address - Street 1:1048 IRVINE AVE # 443
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4602
Mailing Address - Country:US
Mailing Address - Phone:949-515-2360
Mailing Address - Fax:949-515-6278
Practice Address - Street 1:1048 IRVINE AVE # 443
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4602
Practice Address - Country:US
Practice Address - Phone:949-515-2360
Practice Address - Fax:949-515-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82171324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility