Immersive Wellness Centers, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

IMMERSIVE WELLNESS CENTERS, LLC

Practice address

120 Cristianitos Road
Unit 14207
San Clemente, CA 92673

Phone

(619) 871-7345

NPI assigned

Apr 23, 2021

Organization subpart

No

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

Authorized official

Name

Angela McMahon, EDD

Title

Coo

Phone

(619) 871-7345

Specialties & licenses 1

Addresses

Other names 1

• Immersive Wellness Centers Doing business as

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1104408780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34145 PACIFIC COAST HWY # 728",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926292808",
            "telephone_number": "619-871-7345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CRISTIANITOS ROAD",
            "address_2": "UNIT 14207",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92673",
            "telephone_number": "619-871-7345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMERSIVE WELLNESS CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-23",
        "last_updated": "2021-04-23",
        "certification_date": "2021-03-30",
        "status": "A",
        "authorized_official_last_name": "MCMAHON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "619-871-7345",
        "authorized_official_credential": "EDD"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "angela_mcmahon9@yahoo.com",
            "affiliation": "N",
            "endpointDescription": "company email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "anjgrlmc@yahoo.com",
            "address_1": "34145 Pacific Coast Hwy # 728",
            "city": "Dana Point",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926292808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Immersive Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Use Disorder Rehabilitation Clinic/Center in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; 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.