Provider Demographics
NPI:1639618218
Name:CALIFORNIA REHAB CAMPUS LLC
Entity Type:Organization
Organization Name:CALIFORNIA REHAB CAMPUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUENSING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-877-2419
Mailing Address - Street 1:34270 PACIFIC COAST HWY STE C
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2847
Mailing Address - Country:US
Mailing Address - Phone:949-877-2419
Mailing Address - Fax:499-308-7789
Practice Address - Street 1:33861 GRANADA DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:833-272-7342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300039AP324500000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
656620OtherTHE JOINT COMMISSION
CA300036CPOtherDEPARTMENT OF HEALTH CARE SERVICES