Organization
RESURGENCE CALIFORNIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANISHA PORRECA (COO)
(888) 700-5053
Entity
Organization
Contact information
Practice address
158 MARION BLVD, FULLERTON, CA 92835-3525
(949) 899-6003
Mailing address
3151 AIRWAY AVE STE E1, COSTA MESA, CA 92626-4620
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300045FP
CA DHCS
CA
Enumeration date
04/09/2020
Last updated
04/09/2020
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