Provider Demographics
NPI:1922548452
Name:DANA POINT REHAB CAMPUS
Entity Type:Organization
Organization Name:DANA POINT REHAB CAMPUS
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 1:34232 PACIFIC COAST HIGHWAY
Mailing Address - Street 2:STE D
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-877-2419
Mailing Address - Fax:
Practice Address - Street 1:33842 ORILLA RD
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2259
Practice Address - Country:US
Practice Address - Phone:949-877-2419
Practice Address - Fax:949-308-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300039DPOtherDEPARTMENT OF HEALTH CARE SERVICES