NPIMap

Organization Active NPI

Beachside Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Santa Ana, CA
National Provider Identifier
1093223877
Registry record updated Oct 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
300315JP Issued in CA
Legal business name
BEACHSIDE RECOVERY LLC
Practice address
12668 Greenwald LN
Santa Ana, CA 92705-1498
Phone
(949) 393-4070
NPI assigned
Jan 16, 2018
Last updated
Oct 28, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BEACHSIDE RECOVERY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 28, 2019

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

Authorized official

Name
Darryle Mackelvey
Title
Supervisor
Phone
(714) 948-6086

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 300315JP CA Primary

Addresses

Primary practice location

12668 Greenwald LN
Santa Ana, CA 92705-1498

Mailing address

PO Box 511330
Los Angeles, CA 90051-7885

National Provider Directory

National Provider Directory
Tax ID family
Beachside Recovery Center LLC11 organizations share this tax ID, including this one
Part of
Beachside Recovery Center LLC

Other organizations with this tax ID 10

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": "1516060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572220800000",
    "number": "1093223877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511330",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900517885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12668 GREENWALD LN",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927051498",
            "telephone_number": "949-393-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHSIDE RECOVERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEACHSIDE RECOVERY LLC",
        "enumeration_date": "2018-01-16",
        "last_updated": "2019-10-28",
        "status": "A",
        "authorized_official_last_name": "MACKELVEY",
        "authorized_official_first_name": "DARRYLE",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "714-948-6086"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300315JP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; 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.