Provider Demographics
NPI:1255750519
Name:SOCAL DETOX, LLC
Entity type:Organization
Organization Name:SOCAL DETOX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BEAUCHAINE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT 47103
Authorized Official - Phone:949-584-5957
Mailing Address - Street 1:1703 AVENIDA SALVADOR
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3268
Mailing Address - Country:US
Mailing Address - Phone:949-584-5957
Mailing Address - Fax:360-323-7285
Practice Address - Street 1:1703 AVENIDA SALVADOR
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3268
Practice Address - Country:US
Practice Address - Phone:949-584-5957
Practice Address - Fax:360-323-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATBD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility