Organization
NDR PACIFIC, INC
Active
Other names
California Coast Detox & Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
REINER VINCENT NUSBAUM (ADMINISTRATOR)
(949) 235-8258
Entity
Organization
Contact information
Practice address
24482 CARACAS ST, DANA POINT, CA 92629-1320
(949) 218-8174
(866) 703-9903
Mailing address
806 AVENIDA PICO, SUITE I-284, SAN CLEMENTE, CA 92673-5639
(949) 235-8258
(866) 703-9903
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
300306AP
CA
101YM0800X
Mental Health Counselor
300306AP
CA
101YP2500X
Professional Counselor
300306AP
CA
324500000X
Substance Abuse Rehabilitation Facility
Primary
300306AP
CA
Other
Enumeration date
03/31/2015
Last updated
03/31/2015
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