NPIMap

Organization Active NPI

Crescent Moon Recovery- Orange County Iop, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Huntington Beach, CA
National Provider Identifier
1497415137
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
CRESCENT MOON RECOVERY- ORANGE COUNTY IOP, LLC
Practice address
308 22ND St
Huntington Beach, CA 92648-3308
Phone
(714) 242-5099
NPI assigned
Dec 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Authorized official

Name
Jeff Evans
Title
Coo
Phone
(646) 761-9659

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Mental Illness Community Based Residential Treatment Facility 320800000X

Addresses

Primary practice location

308 22ND St
Huntington Beach, CA 92648-3308

Mailing address

308 22ND St
Huntington Beach, CA 92648-3308
Phone (714) 242-5099

National Provider Directory

National Provider Directory
Tax ID family
Crescent Moon Recovery- Orange County Iop LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641772800000",
    "number": "1497415137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 22ND ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926483308",
            "telephone_number": "714-242-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 22ND ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926483308",
            "telephone_number": "714-242-5099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MOON RECOVERY- ORANGE COUNTY IOP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "646-761-9659"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jan 10, 2022; 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.