NPIMap

Organization Active NPI

21St Century Wellness, Inc

Doing business as Rebecca's House Eating Disorder Treatment Programs

  • Adult Mental Health Clinic/Center
  • Lake Forest, CA
National Provider Identifier
1619921657
Registry record updated Oct 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
21ST CENTURY WELLNESS, INC
Doing business as
Rebecca's House Eating Disorder Treatment Programs
Practice address
23792 Rockfield Blvd Ste 100
Lake Forest, CA 92630-2868
Phone
(800) 711-2062
Fax
(949) 900-8268
NPI assigned
May 22, 2006
Last updated
Oct 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2014

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

Authorized official

Name
Mrs. Rebecca Burge Cooper, MFT
Title
Ceo
Phone
(800) 711-2062

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 300211AP CA

Addresses

Primary practice location

23792 Rockfield Blvd Ste 100
Lake Forest, CA 92630-2868

Mailing address

23792 Rockfield Blvd Ste 100
Lake Forest, CA 92630-2868
Phone (800) 711-2062

Other identifiers 1

IdentifierTypeStateIssuer
1619921657OtherCA21ST CENTURY WELLNESS, INC

Other names 1

  • Rebecca's House Eating Disorder Treatment Programs Doing business as

National Provider Directory

National Provider Directory

Locations

23792 Rockfield Blvd
Ste 100
Lake Forest, CA 92630

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1619921657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23792 ROCKFIELD BLVD STE 100",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302868",
            "telephone_number": "800-711-2062",
            "fax_number": "949-900-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23792 ROCKFIELD BLVD STE 100",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926302868",
            "telephone_number": "800-711-2062",
            "fax_number": "949-900-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "21ST CENTURY WELLNESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "BURGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-711-2062",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "300211AP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "21ST CENTURY WELLNESS, INC",
            "identifier": "1619921657",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rebecca's House Eating Disorder Treatment Programs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Forest, CA

Sources for this page

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