SOCAL DETOX, LLC (NPI# 1710445770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710445770 |
| Entity Type | Organization |
| Organization Name | SOCAL DETOX, LLC |
| Practice Address |
1101 Sw Coventry Blvd Bentonville AR 72712-4325 |
| Mailing Address |
835 Avenida Salvador San Clemente CA 92672-2322 |
| Practice Telephone | 9495845957 |
| Mailing Telephone | 9495845957 |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-03-08 |
| Authorized Official Name | JOSHUA LAWRENCE BEAUCHAINE (CEO) |
| Authorized Official Telephone | 9495845957 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871941583 | Socal Detox, LLC | Substance Abuse Rehabilitation Facility | 835 Avenida Salvador, San Clemente, CA 92672-2322 | 2016-06-03 |
| 1730535501 | Socal Detox, LLC | Substance Abuse Rehabilitation Facility | 20555 Fortuna Del Sur, Escondido, CA 92029-4507 | 2016-05-10 |
| 1255750519 | Socal Detox, LLC | Substance Abuse Rehabilitation Facility | 1703 Avenida Salvador, San Clemente, CA 92672-3268 | 2014-04-15 |
| Street Address |
1101 SW COVENTRY BLVD |
| City | BENTONVILLE |
| State | AR |
| Zip Code | 72712-4325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003461955 | Eaglecrest Recovery LLC | Substance Abuse Rehabilitation Facility | 1101 Sw Coventry Blvd, Bentonville, AR 72712-4325 | 2019-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662345 | Bentonville Ambulatory Surgery Center, LLC | Pain Medicine | 2902 We Mid-cities Dr, Bentonville, AR 72712 | 2020-09-08 |
| 1942837059 | Amy Crumpton | Counselor | 3504 Se Riveria Road, Bentonville, AR 72712 | 2020-03-26 |
| 1295361509 | Unbridled Holdings LLC | Physical Therapy Assistant | 9900 Price Coffee Rd, Bentonville, AR 72712 | 2020-03-18 |
| 1649803552 | Hanna Kathryn Baxendale | Pediatrics | 2900 Medical Pkwy, Ste #370, Bentonville, AR 72712 | 2020-02-19 |
| 1740746635 | Meredith C Hodges | Counselor | 2508 Se 2oth St, Bentonville, AR 72712 | 2019-02-15 |
| 1609352566 | Tripharma Inc | Pharmacy | 3500 Sw Regional Airport Blvd Ste 2, Bentonville, AR 72712 | 2018-07-13 |
| 1811406747 | Upspring Therapy, LLC | Counselor | 2106 Sw Walton Blvd, Suite B, Bentonville, AR 72712 | 2017-09-22 |
| 1023536836 | Charlotte Yuvonne Hoyle | Case Manager/Care Coordinator | 2005 S.e Walton Blvd., Bentonville, AR 72712 | 2017-08-31 |
| 1508399502 | Rosanna Nicole Rephan | Nurse Practitioner | 3101 14th St, Mercy Convenient Care, Bentonville, AR 72712 | 2017-04-06 |
| 1417305517 | Charlotte Lennette Stephenson | Behavioral Analyst | 2005 S.e. Walton Blvd., Bentonville, AR 72712 | 2016-05-31 |
| Find all providers in zip 72712 | ||||
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104398460 | 5 Residential LLC | Substance Abuse Rehabilitation Facility | 2209 Grant Ave Ste A, Jonesboro, AR 72401-6195 | 2018-12-27 |
| 1992941363 | Rejuvenation | Substance Abuse Rehabilitation Facility | 154 Huntsville Rd, Eureka Springs, AR 72632-9730 | 2009-01-06 |
| 1528274552 | Capstone Treatment Center | Substance Abuse Rehabilitation Facility | 120 Meghan Ln, Judsonia, AR 72081-9302 | 2007-05-15 |
| City | BENTONVILLE |
| Zip Code | 72712 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.