Organization
CRESCENT MOON RECOVERY- ORANGE COUNTY IOP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF EVANS (COO)
(646) 761-9659
Entity
Organization
Contact information
Practice address
308 22ND ST, HUNTINGTON BEACH, CA 92648-3308
(714) 242-5099
Mailing address
308 22ND ST, HUNTINGTON BEACH, CA 92648-3308
(714) 242-5099
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/21/2021
Last updated
01/10/2022
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