Sullivans Detox and Residential Treatment LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SULLIVANS DETOX AND RESIDENTIAL TREATMENT LLC

Practice address

24731 Via San Fernando
Mission Viejo, CA 92692-2431

Phone

(949) 735-1576

NPI assigned

Aug 21, 2023

Organization subpart

No

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

Authorized official

Name

Cory Sullivan

Title

Ceo

Phone

(714) 757-7266

Specialties & licenses 1

Addresses

Other names 1

• Sullivan Recovery Doing business as

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1801670997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 CONGRESS ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273339",
            "telephone_number": "714-757-7266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24731 VIA SAN FERNANDO",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926922431",
            "telephone_number": "949-735-1576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVANS DETOX AND RESIDENTIAL TREATMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "CORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-757-7266"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gary Louis Sugarman, M.D.
• Gerald Sugino, M.D.
• Joshua Sugino, DO
• Joy Sullivan, M.A.
• Lisa Sullivan
• Summer Brown, a Nursing Corporation
• Summer Brown, a Nursing Corporation
• Aykanush Sungulyan, O.D.
• Srinivasu Ammisetti Sunkara, MD
• Sunny Bay Home Care LLC

• Substance Abuse Rehabilitation Facility in Mission Viejo, CA
• Providers in Mission Viejo, 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 Aug 21, 2023; 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.