Organization
21ST CENTURY WELLNESS, INC
Active
Other names
Rebecca's House Eating Disorder Treatment Programs
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA BURGE COOPER MFT (CEO)
(800) 711-2062
Entity
Organization
Contact information
Practice address
23792 ROCKFIELD BLVD STE 100, LAKE FOREST, CA 92630-2868
(800) 711-2062
(949) 900-8268
Mailing address
23792 ROCKFIELD BLVD STE 100, LAKE FOREST, CA 92630-2868
(800) 711-2062
(949) 900-8268
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
300211AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619921657
21ST CENTURY WELLNESS, INC
CA
Enumeration date
05/22/2006
Last updated
10/20/2014
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