Provider Demographics
NPI:1578013603
Name:SURF CITY RECOVERY
Entity Type:Organization
Organization Name:SURF CITY RECOVERY
Other - Org Name:SURF CITY RECOVERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-841-3863
Mailing Address - Street 1:18090 BEACH BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1327
Mailing Address - Country:US
Mailing Address - Phone:949-209-7765
Mailing Address - Fax:
Practice Address - Street 1:6002 DOYLE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4219
Practice Address - Country:US
Practice Address - Phone:949-209-7765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300267BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility