Organization
BEACHSIDE RECOVERY CENTER LLC
Active
Parent organization
BEACHSIDE RECOVERY CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACHSIDE RECOVERY CENTER LLC
Authorized official
MR. SCOTT WILSON (REGIONAL PROGRAM DIRECTOR)
(949) 430-7824
Entity
Organization
Contact information
Practice address
7800 SW BARBUR BLVD, PORTLAND, OR 97219-2823
(949) 430-7824
Mailing address
PO BOX 511330, LOS ANGELES, CA 90051-7885
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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