Organization
CALIFORNIA COASTAL RECOVERY CENTERS
Active
Other names
Immersive Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WESLEY HEIM (PROGRAM ADMINISTRATOR)
(858) 342-9151
Entity
Organization
Contact information
Practice address
2236 ENCINITAS BLVD STE DEFGH, ENCINITAS, CA 92024-4352
(858) 342-9151
Mailing address
2236 ENCINITAS BLVD STE D, ENCINITAS, CA 92024-4375
(858) 342-9151
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370169AP
STATE CERTIFICATION
CA
Enumeration date
05/17/2017
Last updated
09/07/2022
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