Organization
SPARKLES KC LLC
Active
Other names
Path To Serenity
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IZZY HIRSON (CEO)
(949) 289-0350
Entity
Organization
Contact information
Practice address
10002 BRILEY WAY, VILLA PARK, CA 92861-4219
(949) 289-0350
Mailing address
8 CHESHIRE CT, NEWPORT BEACH, CA 92660-4210
(949) 289-0350
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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