NPIMap

Organization Active NPI

Resurgence California, LLC

  • Substance Abuse Rehabilitation Facility
  • Fullerton, CA
National Provider Identifier
1003435033
Registry record updated Apr 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
RESURGENCE CALIFORNIA, LLC
Practice address
158 Marion Blvd
Fullerton, CA 92835-3525
Phone
(949) 899-6003
NPI assigned
Apr 9, 2020
Last updated
Apr 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tanisha Porreca
Title
Coo
Phone
(888) 700-5053

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

158 Marion Blvd
Fullerton, CA 92835-3525

Mailing address

3151 Airway Ave Ste E1
Costa Mesa, CA 92626-4620

Other identifiers 1

IdentifierTypeStateIssuer
300045FPOtherCACA DHCS

National Provider Directory

National Provider Directory
Tax ID family
Resurgence California LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1003435033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE STE E1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MARION BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353525",
            "telephone_number": "949-899-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESURGENCE CALIFORNIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "PORRECA",
        "authorized_official_first_name": "TANISHA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "888-700-5053"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DHCS",
            "identifier": "300045FP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.