Provider Demographics
NPI:1417739178
Name:DETOX CALIFORNIA AT CLIFFSIDE CAPISTRANO INC
Entity Type:Organization
Organization Name:DETOX CALIFORNIA AT CLIFFSIDE CAPISTRANO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-512-1694
Mailing Address - Street 1:2942 CENTURY PL # 716
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4324
Mailing Address - Country:US
Mailing Address - Phone:805-512-1694
Mailing Address - Fax:
Practice Address - Street 1:35341 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92624-1803
Practice Address - Country:US
Practice Address - Phone:312-315-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility