Organization
PURE LIFE RECOVERY, LLC
Active
Other names
Shoreline Ranch
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BEN BEAUCHAINE (CEO)
(714) 417-7628
Entity
Organization
Contact information
Practice address
19915 FORTUNA DEL ESTE, ESCONDIDO, CA 92029-5917
(760) 290-4749
Mailing address
901 CALLE AMANECER, SUITE 255, SAN CLEMENTE, CA 92673-6278
(949) 629-3936
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
370174AP
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370174AP
STATE LICENSE - DHCS
CA
Enumeration date
11/29/2016
Last updated
04/24/2017
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