Laguna Beach Recovery

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

300197AP Issued in CA

Legal business name

LAGUNA BEACH RECOVERY

Practice address

316 Thalia St
Laguna Beach, CA 92651-2714

Phone

(866) 493-4527

Fax

(949) 497-3687

NPI assigned

Sep 5, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Mark Ronald Kisner, MSW, CADC-IINPI 1922257484

Title

Clinical Director

Phone

(714) 913-0852

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Ronald Kisner, MSW, CADC-II

  • Addiction (Substance Use Disorder) Counselor
  • Laguna Beach, CA
  • NPI 1922257484
  NPD (past) Authorized official
• Keri Loraine Smith, B.S.

  • Addiction (Substance Use Disorder) Counselor
  • Laguna Beach, CA
  • NPI 1609025618
  NPD (past)

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

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220572800000",
    "number": "1265680953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 THALIA ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512714",
            "telephone_number": "866-493-4527",
            "fax_number": "949-497-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 THALIA ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512714",
            "telephone_number": "866-493-4527",
            "fax_number": "949-497-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGUNA BEACH RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-05",
        "last_updated": "2008-09-05",
        "status": "A",
        "authorized_official_last_name": "KISNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "RONALD",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "714-913-0852",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, CADC-II"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300197AP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE/CERTIFICATION DRUG AND ALCOHOL",
            "identifier": "300197AP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabor L Kovacs, M.D.
• Kaitlyn Kuo, PSYD
• Laguna Aesthetics & Family Wellness Center, Inc
• Laguna Beach Community Clinic, Inc.
• Laguna Beach Dental Excellence
• Laguna Beach Recovery LLC
• Laguna Beach Recovery LLC
• Laguna Beach Rehab Inc
• Laguna Beach Treatment
• Laguna Beach Urgent Care, Inc.

• Substance Abuse Rehabilitation Facility in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; 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.