Organization
SOUTHERN CALIFORNIA RECOVERY CENTERS OCEANSIDE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS PENNY (MANAGER)
(949) 481-6156
Entity
Organization
Contact information
Practice address
2850 PIO PICO DR STE A-D, CARLSBAD, CA 92008-1554
(760) 517-1758
(949) 542-3878
Mailing address
2850 PIO PICO DR STE A-D, CARLSBAD, CA 92008-1554
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
370158AP
CA
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2146685
CLIA
—
01
—
370158AP
STATE OF CALIFORNIA
CA
01
—
CDF00352100
STATE OF CALIFORNIA
CA
Enumeration date
12/05/2017
Last updated
03/21/2019
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