Organization
BEACHSIDE RECOVERY CENTER LLC
Active
Parent organization
BEACHSIDE RECOVERY CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEACHSIDE RECOVERY CENTER LLC
Authorized official
DARRYLE MACKELVEY (SUPERVISOR)
(714) 948-6086
Entity
Organization
Contact information
Practice address
15548 SONORA ST, TUSTIN, CA 92782-1936
(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
300315DP
CA
Other
Enumeration date
11/27/2017
Last updated
10/28/2019
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