1043450596 NPI number — OCEAN HILLS RECOVERY INC.

Table of content: (NPI 1043450596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043450596 NPI number — OCEAN HILLS RECOVERY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN HILLS RECOVERY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043450596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27124 PASEO ESPADA
Provider Second Line Business Mailing Address:
SUITE 805
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-2741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-388-0112
Provider Business Mailing Address Fax Number:
949-388-4625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33242 CHRISTINA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANA POINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92629-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-388-0112
Provider Business Practice Location Address Fax Number:
949-388-4625
Provider Enumeration Date:
02/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOSS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
949-388-0112

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  300208AP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)