Pure Life Recovery, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

370174AP Issued in CA

Legal business name

PURE LIFE RECOVERY, LLC

Doing business as

Shoreline Ranch

Practice address

19915 Fortuna del Este
Escondido, CA 92029-5917

Phone

(760) 290-4749

NPI assigned

Nov 29, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Ben Beauchaine

Title

Ceo

Phone

(714) 417-7628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shoreline Ranch Doing business as

Tax ID family

Pure Life Recovery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Pure Life Recovery

  • Substance Abuse Rehabilitation Facility
  • San Clemente, CA
  • NPI 1225422066
  NPD tax ID

Locations

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

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1912440645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 CALLE AMANECER",
            "address_2": "SUITE 255",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736278",
            "telephone_number": "949-629-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19915 FORTUNA DEL ESTE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920295917",
            "telephone_number": "760-290-4749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE LIFE RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-29",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "BEAUCHAINE",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-417-7628",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "370174AP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE - DHCS",
            "identifier": "370174AP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoreline Ranch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glen Thomas Pugh, N.P.
• Dennis Pulangas
• Rocio Pulido Garcia, NP
• Jose R Pulido, DDS
• Christien Angelo Borja Punzalan
• Jocelyn R Putnam
• Qiuling Qin
• Qualitycare Medical Center
• Rosita Tan Que, FAMILY NURSE PRACTIT
• Cindy Quejada, PHARMD

• Substance Abuse Rehabilitation Facility in Escondido, CA
• Providers in Escondido, 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 Apr 24, 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.