The Duck House, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

300358AP Issued in CA

Legal business name

THE DUCK HOUSE, LLC

Practice address

952 Dahlia Ave
Costa Mesa, CA 92626-1739

Phone

(714) 598-7467

NPI assigned

Mar 1, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Ahmad Ali Kohzad, PHARMD

Title

Owner/Ceo

Phone

(714) 598-7467

Specialties & licenses 1

Addresses

Other names 1

• The Duck House Doing business as

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

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1679013288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "952 DAHLIA AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "952 DAHLIA AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261739",
            "telephone_number": "714-598-7467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DUCK HOUSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-01",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "KOHZAD",
        "authorized_official_first_name": "AHMAD",
        "authorized_official_middle_name": "ALI",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "714-598-7467",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300358AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Duck House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Costa Mesa, CA
• Providers in Costa Mesa, 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 Mar 1, 2017; 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.