Organization
BEACHSIDE RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYLE MACKELVEY (SUPERVISOR)
(949) 430-2874
Entity
Organization
Contact information
Practice address
24662 SANTA CLARA AVE, DANA POINT, CA 92629-3026
(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
300315AP
CA
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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