Provider Demographics
NPI:1679107791
Name:TRUE NORTH DETOX LLC
Entity Type:Organization
Organization Name:TRUE NORTH DETOX LLC
Other - Org Name:FIRST STEPS RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-417-7628
Mailing Address - Street 1:2121 HERNDON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6302
Mailing Address - Country:US
Mailing Address - Phone:559-341-0494
Mailing Address - Fax:559-793-7258
Practice Address - Street 1:10422 N ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8693
Practice Address - Country:US
Practice Address - Phone:844-244-7837
Practice Address - Fax:559-793-7258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUE NORTH DETOX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-27
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100094APOtherDHCS LICENSE