Organization
LA COSTA RECOVERY LLC
Active
Other names
Leucadia Detox
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW LEE (ADMIN)
(619) 987-8078
Entity
Organization
Contact information
Practice address
136 E JASON ST, ENCINITAS, CA 92024-1671
(949) 359-5669
Mailing address
34249 CAMINO CAPISTRANO STE 101, CAPISTRANO BEACH, CA 92624-1156
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370238AP
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
05/03/2024
Last updated
06/16/2025
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