Organization
417 SAN CLEMENTE, LLC
Active
Organization
417 SAN CLEMENTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT CHRISTIAN KALLAND (OWNER/PRESIDENT)
(949) 525-7977
Entity
Organization
Contact information
Practice address
26010 ACERO STE 200, MISSION VIEJO, CA 92691-6716
(949) 525-7977
Mailing address
26010 ACERO STE 200, MISSION VIEJO, CA 92691-6716
(949) 525-7977
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/22/2015
Last updated
07/02/2019
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