417 San Clemente, LLC

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

417 SAN CLEMENTE, LLC

Practice address

26010 Acero Ste 200
Mission Viejo, CA 92691-6716

Phone

(949) 525-7977

NPI assigned

Jul 22, 2015

Last updated

Jul 2, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Scott Christian Kalland

Title

Owner/President

Phone

(949) 525-7977

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562025600000",
    "number": "1770968513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26010 ACERO STE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916716",
            "telephone_number": "949-525-7977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26010 ACERO STE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916716",
            "telephone_number": "949-525-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "417 SAN CLEMENTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-22",
        "last_updated": "2019-07-02",
        "status": "A",
        "authorized_official_last_name": "KALLAND",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "CHRISTIAN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "949-525-7977",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Children's Substance Abuse Rehabilitation Facility in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Children's Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; 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.