Organization
HOWER LODGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER GATES (CCO/MANAGING MEMBER)
(949) 701-1959
Entity
Organization
Contact information
Practice address
2220 POMONA AVE, COSTA MESA, CA 92627-5933
(949) 701-1959
(949) 258-5510
Mailing address
33171 PASEO CERVEZA, SAN JUAN CAPISTRANO, CA 92675-4824
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2290089
CLIA
CA
01
—
300733AP
DEPARTMENT OF HEALTH SERVICES
—
Enumeration date
01/05/2024
Last updated
01/26/2024
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