NPIMap

Organization Active NPI

Pat Moore Detox, LLC

  • Substance Abuse Rehabilitation Facility
  • Costa Mesa, CA
National Provider Identifier
1245657873
Registry record updated Mar 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
300274AP Issued in CA
Legal business name
PAT MOORE DETOX, LLC
Practice address
536 Hamilton St
Units a, B and C
Costa Mesa, CA 92627-2617
Phone
(949) 646-2830
Fax
(949) 646-3028
NPI assigned
Mar 20, 2014
Organization subpart
Yes
Parent organization
SPROUT HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 20, 2014

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

Authorized official

Name
Arel Meister-Aldama
Title
Owner
Phone
(914) 960-0080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 300274AP CA Primary

Addresses

Primary practice location

536 Hamilton St
Units a, B and C
Costa Mesa, CA 92627-2617

Mailing address

536 Hamilton St
Units a, B and C
Costa Mesa, CA 92627-2617
Phone (949) 646-2830

National Provider Directory

National Provider Directory
Tax ID family
Pat Moore Detox 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.

NPI Registry JSON

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

{
    "created_epoch": "1395273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395273600000",
    "number": "1245657873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "536 HAMILTON ST",
            "address_2": "UNITS A, B AND C",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272617",
            "telephone_number": "949-646-2830",
            "fax_number": "949-646-3028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "536 HAMILTON ST",
            "address_2": "UNITS A, B AND C",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926272617",
            "telephone_number": "949-646-2830",
            "fax_number": "949-646-3028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAT MOORE DETOX, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPROUT HEALTH, LLC",
        "enumeration_date": "2014-03-20",
        "last_updated": "2014-03-20",
        "status": "A",
        "authorized_official_last_name": "MEISTER-ALDAMA",
        "authorized_official_first_name": "AREL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-960-0080"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300274AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.