Provider Demographics
NPI:1134585730
Name:WEST COAST REHAB, LLC
Entity type:Organization
Organization Name:WEST COAST REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CASE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:480-612-4297
Mailing Address - Street 1:35 S PEAK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2903
Mailing Address - Country:US
Mailing Address - Phone:949-218-4141
Mailing Address - Fax:480-383-6983
Practice Address - Street 1:30552 HILLTOP WAY
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2048
Practice Address - Country:US
Practice Address - Phone:949-218-4141
Practice Address - Fax:480-383-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility