NPIMap

Organization Active NPI

Beachside Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Dana Point, CA
National Provider Identifier
1962880914
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
300315AP Issued in CA
Legal business name
BEACHSIDE RECOVERY LLC
Practice address
24662 Santa Clara Ave
Dana Point, CA 92629-3026
Phone
(949) 393-4070
NPI assigned
May 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Authorized official

Name
Darryle Mackelvey
Title
Supervisor
Phone
(949) 430-2874

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 300315AP CA Primary

Addresses

Primary practice location

24662 Santa Clara Ave
Dana Point, CA 92629-3026

Mailing address

PO Box 511330
Los Angeles, CA 90051-7885

National Provider Directory

National Provider Directory
Tax ID family
Beachside Recovery Center LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431302400000",
    "number": "1962880914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511330",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900517885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24662 SANTA CLARA AVE",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926293026",
            "telephone_number": "949-393-4070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACHSIDE RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-05-11",
        "status": "A",
        "authorized_official_last_name": "MACKELVEY",
        "authorized_official_first_name": "DARRYLE",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "949-430-2874"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300315AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dana Point, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; 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.