Organization
CRESCENT MOON RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADAM WADE MD (EXECUTIVE DIRECTOR)
(661) 706-8898
Entity
Organization
Contact information
Practice address
18652 FLORIDA ST, SUITE 200, HUNTINGTON BEACH, CA 92648-6000
(714) 464-8474
(714) 948-8883
Mailing address
18652 FLORIDA ST STE 200, HUNTINGTON BEACH, CA 92648-6000
(714) 464-8474
(714) 948-8883
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2207074
CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE, CLIA ID
—
01
—
300398AP
CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES, OUTPATIENT CERTIFICATION
CA
01
—
661764
THE JOINT COMMISSION
—
01
—
CLR-90002425
CDPH CLIA LICENSE, STATE ID
CA
Enumeration date
12/08/2021
Last updated
04/30/2024
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