Provider Demographics
NPI:1598129777
Name:REMEDY DETOX CENTERS LLC
Entity Type:Organization
Organization Name:REMEDY DETOX CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-270-6344
Mailing Address - Street 1:6621 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4200
Mailing Address - Country:US
Mailing Address - Phone:562-270-6344
Mailing Address - Fax:
Practice Address - Street 1:6621 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4200
Practice Address - Country:US
Practice Address - Phone:562-270-6344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility