Organization
BEACHSIDE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYLE LEE MACKELVEY (SUPERVISOR)
(714) 948-6086
Entity
Organization
Contact information
Practice address
16490 HARBOR BLVD. A-B, FOUNTAIN VALLEY, CA 92708
(949) 393-4070
Mailing address
PO BOX 511330, LOS ANGELES, CA 90051-7885
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
300315BP
CA
Other
Enumeration date
05/12/2015
Last updated
12/10/2018
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