417 SAN CLEMENTE, LLC (NPI# 1770968513) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770968513 |
| Entity Type | Organization |
| Organization Name | 417 SAN CLEMENTE, LLC |
| Practice Address |
26010 Acero Ste 200 Mission Viejo CA 92691-6716 |
| Practice Telephone | 9495257977 |
| Mailing Telephone | 9495257977 |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2019-07-02 |
| Authorized Official Name | MR. SCOTT CHRISTIAN KALLAND (OWNER/PRESIDENT) |
| Authorized Official Telephone | 9495257977 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities |
| Street Address |
26010 ACERO STE 200 |
| City | MISSION VIEJO |
| State | CA |
| Zip Code | 92691-6716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748247 | Sonja Wood | Registered Nurse | 92691 Avenida Deseo, Mission Viejo, CA 92691 | 2020-04-09 |
| 1912488487 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 27551 Puerta Real, Mission Viejo, CA 92691 | 2018-08-23 |
| 1518457704 | Leon Baginski Md Inc | Obstetrics & Gynecology | 26800 Crown Valley Pkwy Ste 560, Mission Viejo, CA 92691 | 2018-05-14 |
| 1215426762 | Gail G Warner | Marriage & Family Therapist | 26050 Acero, Suite 301, Mission Viejo, CA 92691 | 2018-05-09 |
| 1508354176 | Tania Choudhary | Student in an Organized Health Care Education/Training Program | 23595 Rangoon St, Mission Viejo, CA 92691 | 2018-04-28 |
| 1710486519 | Aubriana Denise Gray | Counselor | 25802 Pacifica Ave, Mission Viejo, CA 92691 | 2018-02-07 |
| 1487162707 | Alberto Israel Galicia | Case Manager/Care Coordinator | 27261 Las Ramblas, Suite 220, Mission Viejo, CA 92691 | 2018-01-22 |
| 1629595244 | Elisabeth A Lischer | Counselor | 26137 La Paz Road, Suite 230, Mission Viejo, CA 92691 | 2017-08-24 |
| 1639694227 | Dr. Horiyat, A Dental Corporation | Dentist | 27652 Crown Valley Parkway, Mission Viejo, CA 92691 | 2017-08-04 |
| 1255851689 | Jackelin Liseth Martinez | Counselor | 25402 Pacifica Avenue, Mission Viejo, CA 92691 | 2017-06-27 |
| Find all providers in zip 92691 | ||||
| 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 |
|---|---|---|---|---|
| 1689275620 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 80 W Nicasio, San Geronimo, CA 94963 | 2020-11-05 |
| 1013518042 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 1208 Via Aracena, Camarillo, CA 93010-7440 | 2020-11-05 |
| 1609477645 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 1850 Calle Alberca, Camarillo, CA 93010-1811 | 2020-11-05 |
| 1467053736 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 615 Bugeia Ln, Novato, CA 94945-1517 | 2020-11-04 |
| 1376144642 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 100 Avocado Pl, Camarillo, CA 93010-8467 | 2020-11-04 |
| 1285235556 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 7210 Johnston Rd, Pleasanton, CA 94588-9466 | 2020-11-04 |
| 1780282988 | Muir Wood LLC | Substance Abuse Rehabilitation Facility | 2891 I Street Ext, Petaluma, CA 94952-9521 | 2020-10-12 |
| 1720692577 | Muir Wood, LLC. | Substance Abuse Rehabilitation Facility | 1743 Skillman Lane, Petaluma, CA 94952-9495 | 2020-08-31 |
| 1598376816 | Muir Wood LLC | Substance Abuse Rehabilitation Facility | 6868 Cold Springs Rd, Penngrove, CA 94951-9722 | 2020-08-11 |
| 1770194060 | Monroe Operations, LLC | Substance Abuse Rehabilitation Facility | 195 S Peralta Hills Dr, Anaheim, CA 92807-3424 | 2020-08-11 |
| Find all providers with the same taxonomy | ||||
| City | MISSION VIEJO |
| Zip Code | 92691 |
Please comment or provide details below to improve the information on 417 SAN CLEMENTE, LLC.
| 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.