417 SAN CLEMENTE, LLC – NPI #1770968513
Substance Abuse Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included.

417 SAN CLEMENTE, LLC is a substance abuse rehabilitation facility located in MISSION VIEJO, CA. NPPES has assigned the NPI number 1770968513 to 417 SAN CLEMENTE, LLC on July 22, 2015. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 3245S0500X from the Health Care Provider Taxonomy code set, which is classified as Substance Abuse Rehabilitation Facility, specializing in Substance Abuse Treatment, Children

The NPI profile was previously updated about 7 years ago on Jul 02, 2019. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for 417 SAN CLEMENTE, LLC below.

NPI Profile for
417 SAN CLEMENTE, LLC

NPI Number
1770968513
Enumeration Date

(about 11 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
417 SAN CLEMENTE, LLC
Primary location
26010 ACERO STE 200
MISSION VIEJO, CA 92691-6716
Phone: (949) 525-7977 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
SCOTT KALLAND
OWNER/PRESIDENT
Phone: (949) 525-7977
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.