Organization
ADDICTION HEALTH ALLIANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LINDSEY MYERS (CEO)
(513) 280-2714
Entity
Organization
Contact information
Practice address
605 AVENIDA LAS FLORES, SAN CLEMENTE, CA 92672
(513) 280-2714
Mailing address
34249 CAMINO CAPISTRANO, CAPISTRANO BEACH, CA 92624-1138
(949) 481-6156
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
300314AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2086673
CLIA
—
01
—
300314AP
LICENSE
CA
Enumeration date
03/30/2016
Last updated
02/20/2020
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