Organization
GRAND TERRACE DETOX AND RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC MCCOY (PROGRAM DIRECTOR)
(954) 446-3538
Entity
Organization
Contact information
Practice address
18989 GRAND AVE, LAKE ELSINORE, CA 92530-6259
(954) 210-8617
(954) 982-2827
Mailing address
18989 GRAND AVE, LAKE ELSINORE, CA 92530-6259
(954) 210-8617
(954) 982-2827
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
330168AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
330168AP
LICENSE AND CERTIFICATION
CA
Enumeration date
08/15/2017
Last updated
07/21/2022
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