Organization
BROADWAY DETOX CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAUN LENNERT (CHIEF OPERATIONS OFFICER)
(714) 655-0948
Entity
Organization
Contact information
Practice address
6021 JADE CIR, HUNTINGTON BEACH, CA 92647-2246
(714) 655-0948
Mailing address
18582 BEACH BLVD, STE 214, HUNTINGTON BEACH, CA 92648-2000
(714) 655-0948
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
CA
Other
Enumeration date
12/21/2015
Last updated
12/21/2015
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