Organization
A MISSION FOR MICHAEL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SMITH III J.D. (EXECUTIVE DIRECTOR)
(714) 392-7306
Entity
Organization
Contact information
Practice address
34270 PACIFIC COAST HWY STE N, DANA POINT, CA 92629-2825
(949) 489-0950
Mailing address
34270 PACIFIC COAST HWY STE N, DANA POINT, CA 92629-2825
(949) 489-0950
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143 717 5189
NPI
CA
Enumeration date
06/08/2013
Last updated
06/08/2013
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