1568875839 NPI number — WINDSTONE ADDICTION CENTERS, INC

Table of content: (NPI 1568875839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568875839 NPI number — WINDSTONE ADDICTION CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINDSTONE ADDICTION CENTERS, 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:
6
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:
1568875839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 KALMUS DR
Provider Second Line Business Mailing Address:
SUITE K-1
Provider Business Mailing Address City Name:
COSTA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92626-5988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-384-3216
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 W PEARL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92801-5940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-833-5604
Provider Business Practice Location Address Fax Number:
714-833-5038
Provider Enumeration Date:
06/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MACDONALD
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
949-307-7748

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com