Provider Demographics
NPI:1538692918
Name:SHORELINE TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:SHORELINE TREATMENT CENTER, LLC
Other - Org Name:SHORELINE CENTER FOR EATING DISORDER TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNACKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-442-7689
Mailing Address - Street 1:191 ARGONNE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3231
Mailing Address - Country:US
Mailing Address - Phone:562-434-6007
Mailing Address - Fax:562-856-2370
Practice Address - Street 1:25401 CABOT RD
Practice Address - Street 2:SUITE 219
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5524
Practice Address - Country:US
Practice Address - Phone:562-434-6007
Practice Address - Fax:562-856-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37703261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)