Organization
COASTLINE RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON JACOBS (VP OF OPERATIONS)
(949) 345-5577
Entity
Organization
Contact information
Practice address
18377 BEACH BLVD STE 210, HUNTINGTON BEACH, CA 92648-1349
(949) 205-1065
(714) 388-3844
Mailing address
18377 BEACH BLVD STE 210, HUNTINGTON BEACH, CA 92648-1349
(949) 205-1065
(714) 388-3844
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
300630BP
CA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
300630BP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300630BP
DHCS CERTIFICATION
CA
01
—
608177
THE JOINT COMMISSION
—
Enumeration date
10/13/2015
Last updated
03/13/2018
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