Organization
SAN DIEGO DETOX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS HATHORN (OWNER/CEO)
(619) 433-4971
Entity
Organization
Contact information
Practice address
16916 DEER HILL ESTS, LAKESIDE, CA 92040-1101
(619) 433-4971
Mailing address
7373 UNIVERSITY AVE STE 113, LA MESA, CA 91942-0523
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/09/2022
Last updated
09/22/2022
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