Provider Demographics
NPI:1851052062
Name:SOCAL EMPOWERED, LLC
Entity Type:Organization
Organization Name:SOCAL EMPOWERED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-313-3841
Mailing Address - Street 1:22602 COSTA BELLA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4218
Mailing Address - Country:US
Mailing Address - Phone:888-846-8569
Mailing Address - Fax:
Practice Address - Street 1:23671 BRASILIA ST
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3047
Practice Address - Country:US
Practice Address - Phone:888-846-8569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306006036OtherDEPARTMENT OF SOCIAL SERVICES