Provider Demographics
NPI:1942952593
Name:CALIFORNIA CARE DETOX & TREATMENT
Entity Type:Organization
Organization Name:CALIFORNIA CARE DETOX & TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUQUET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-291-3333
Mailing Address - Street 1:27068 LA PAZ RD # 649
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3041
Mailing Address - Country:US
Mailing Address - Phone:949-291-3333
Mailing Address - Fax:
Practice Address - Street 1:27075 CABOT RD STE 109
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7014
Practice Address - Country:US
Practice Address - Phone:949-291-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health