Organization
PURE LIFE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY WILHITE (PRESIDENT)
(949) 899-0895
Entity
Organization
Contact information
Practice address
1 CALLE SALTAMONTES, SAN CLEMENTE, CA 92673-7004
(949) 393-5033
Mailing address
1620 CENTRAL AVE, SUITE 202, CHEYENNE, WY 82001-4557
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
300308BP
CA
291U00000X
Clinical Medical Laboratory
—
CA
324500000X
Substance Abuse Rehabilitation Facility
Primary
300308BP
CA
Other
Enumeration date
03/18/2015
Last updated
03/18/2015
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