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Organization

SUMMIT COASTAL LIVING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KEITH B RANDLE (PRESIDENT)
(949) 689-8880
Entity
Organization

Contact information

Practice address
165 E WILSON ST # B, COSTA MESA, CA 92627-1564
(949) 689-8880
Mailing address
PO BOX 2028, NEWPORT BEACH, CA 92659-1028
(949) 689-8880

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
C50412
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C50412
DR. KAMBIZ KARIMI
CA
Enumeration date
03/29/2016
Last updated
03/29/2016
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