Provider Demographics
NPI:1346614666
Name:SOUTHERN CALIFORNIA ADDICTION CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA ADDICTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-619-5081
Mailing Address - Street 1:2755 BRISTOL STREET
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-619-5081
Mailing Address - Fax:206-426-7551
Practice Address - Street 1:36500 DE PORTOLA RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-7801
Practice Address - Country:US
Practice Address - Phone:951-302-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility