Organization Name: | PACIFIC SOLSTICE, LLC |
NPI Number: | 1053771782 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EVAN FEWSMITH (PROGRAM DIRECTOR) |
Mailing Address: | 23461 S Pointe Dr 340 Laguna Hills |
State: | CA US |
Postal Code: | 926531547 |
Phone Number: | 9492007929 |
Fax Number: | |
NPI Enumeration Date: | 02/23/2016 |
NPI Last Update Date: | 02/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | 300636AP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |