Provider Demographics
NPI:1639768914
Name:BEWELL ORANGE COUNTY LLC
Entity Type:Organization
Organization Name:BEWELL ORANGE COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-751-4330
Mailing Address - Street 1:1953 SAN ELIJO AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2348
Mailing Address - Country:US
Mailing Address - Phone:302-636-5401
Mailing Address - Fax:
Practice Address - Street 1:27130A PASEO ESPADA STE 1423
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2717
Practice Address - Country:US
Practice Address - Phone:949-529-5945
Practice Address - Fax:949-529-5946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility