NPIMap

Organization Active NPI

Crescent Moon Recovery, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Huntington Beach, CA
National Provider Identifier
1083200307
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CRESCENT MOON RECOVERY, LLC
Practice address
18377 Beach Blvd Ste 210
Huntington Beach, CA 92648-1349
Phone
(714) 841-2260
NPI assigned
Dec 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Authorized official

Name
Dr. Adam Wade, MDNPI 1760914329
Title
Ceo
Phone
(661) 706-8898

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

18377 Beach Blvd Ste 210
Huntington Beach, CA 92648-1349

Mailing address

18377 Beach Blvd Ste 210
Huntington Beach, CA 92648-1349
Phone (714) 841-2260

National Provider Directory

National Provider Directory
Tax ID family
Crescent Moon Recovery LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1608508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641772800000",
    "number": "1083200307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18377 BEACH BLVD STE 210",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481349",
            "telephone_number": "714-841-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18377 BEACH BLVD STE 210",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926481349",
            "telephone_number": "714-841-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MOON RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-21",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-706-8898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; 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.