NPIMap

Organization Active NPI

Crescent Moon Recovery, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Huntington Beach, CA
National Provider Identifier
1497414379
Registry record updated Apr 30, 2024
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
18652 Florida St
Suite 200
Huntington Beach, CA 92648-6000
Phone
(714) 464-8474
Fax
(714) 948-8883
NPI assigned
Dec 8, 2021
Last updated
Apr 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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
Executive Director
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

18652 Florida St
Suite 200
Huntington Beach, CA 92648-6000

Mailing address

18652 Florida St Ste 200
Huntington Beach, CA 92648-6000
Phone (714) 464-8474

Other identifiers 4

IdentifierTypeStateIssuer
CLR-90002425OtherCACDPH CLIA LICENSE, STATE ID
300398APOtherCACALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES, OUTPATIENT CERTIFICATION
661764OtherTHE JOINT COMMISSION
05D2207074OtherCLINICAL AND PUBLIC HEALTH LABORATORY LICENSE, CLIA ID

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.

Locations

18652 Florida St
Ste 200
Huntington Beach, CA 92648
Phone (714) 464-8474

Practitioners & affiliated clinicians

Practitioners 1

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": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1497414379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18652 FLORIDA ST STE 200",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926486000",
            "telephone_number": "714-464-8474",
            "fax_number": "714-948-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18652 FLORIDA ST",
            "address_2": "SUITE 200",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926486000",
            "telephone_number": "714-464-8474",
            "fax_number": "714-948-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MOON RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2024-04-30",
        "certification_date": "2021-11-30",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "661-706-8898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPH CLIA LICENSE, STATE ID",
            "identifier": "CLR-90002425",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES, OUTPATIENT CERTIFICATION",
            "identifier": "300398AP",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE JOINT COMMISSION",
            "identifier": "661764",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICAL AND PUBLIC HEALTH LABORATORY LICENSE, CLIA ID",
            "identifier": "05D2207074",
            "state": null
        }
    ],
    "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 Apr 30, 2024; 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.