Provider Demographics
NPI:1649867797
Name:DANA POINT REHAB CAMPUS GROUP LLC
Entity type:Organization
Organization Name:DANA POINT REHAB CAMPUS GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-201-8831
Mailing Address - Street 1:34232 PACIFIC COAST HWY STE D
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3856
Mailing Address - Country:US
Mailing Address - Phone:949-317-4057
Mailing Address - Fax:888-965-9813
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:949-317-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility